NAME OF TYPE OF DESIGNATION PREVIOUS YEAR’S DATA AMOUNT REMARKS
PUBLIC OFFICER APPLICATION (e.g. FROM TO RISK NO. BOND WITH PENDING WITH Disbursing/Collecti ACCOUNTABILI BOND PREMIUM COVERAG ADMINISTRATIV PENDING on/Signing officer) TY E CASE (Yes or No) CRIMINAL CASE (Yes or No) FOR RENEWAL BASIT, RIGY NEW (1) Punong 608,703.68 285,000.00 4,275.00 1 yr(s) NO NO BRAZA Barangay
TOTAL
Prepared by: Reviewed by: Certified and Approved by:
CARL JAMES D. RIGY B. BASIT TRIA Punong Barangay Barangay Treasurer __________________________ Signature over printed name Signature over printed name Signature over printed name Designation of Authorized position position Official