REQUEST AND REPLY FORM

DATE : _____________________
BRANCH : _____________________
REQUEST : _____________________

I. BACKGROUND ( Explain brief background of your request)

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II. JUSTIFY (Make your recommendation; provide copy of any documents that will support your claim.)
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REQUESTED BY: RECOMMENDED BY: ___________________________

Signature Over Printed Name Signature Over Printed Name

REPLY (This shall be filled up by the approving head in response to the above mention request)
APPROVED DISAPPROVED
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CHECKED BY:_________________ APPROVED/DISAPPROVED:_____________________