Republic of the Philippines

_______________ Judicial Region

_______________ TRIAL COURT
Branch _______________

People of the Philippines Crim. Case No. ______________

- versus –
_____________________,
Accused
X---------------------------X

APPLICATION FOR PROBATION

The undersigned accused, ___________________________________ a petitioner for probation

under the provisions of PD 968 as amended, hereby declares:

1. That Petitioner is _______ years of age, single/married/widow/widower and a resident of

________________________________________________________;

2. That Petitioner has been convicted of __________________________________ and sentenced to serve

a term of imprisonment of not more than six (6) years or to pay a fine of not more than One Thousand
Pesos (Ᵽ1,000.00) with subsidiary imprisonment in case of insolvency;

3. That Petitioner has not begun to serve the term of imprisonment imposed nor paid the fine imposed;

4. That the crime of which Petitioner has been convicted is not an offense against the national security;

5. That Petitioner has not previously been convicted by final judgment of any offense punished by
imprisonment of not more than six (6) months and one (1) day or a fine of not more than one thousand
pesos (Ᵽ1000.00); and 6. That Petitioner has not been once on probation under the provisions of PD 968
as amended.
_____________________________ _______________________ (Place) (Date)
____________________________________