Application for PLEB Clearance Form as of August 2016 Republic of the Philippines PEOPLE’S LAW ENFORCEMENT BOARD. ‘8/F Makati City Hall, Poblacion, Makati City 1210 REQUIREMENTS: Duly Accomplished Form and PNP LD. Certified Copy of Service Record,/Duty Status for Retirement and Promotion Purposes Endorsement from PNP Admin. Office for Retirement, Promotion, Transfer of Assignment, Medaiya ng Mabuting Asal Barangay Clearance (if PNPmember is not assigned at Makati Police Station) APPLICATION FOR PLEB CLEARANCE PURPOSE OF CLEARANCE : Please indicate your purpose by checking v the appropriate box. CO Retirement Provident Loan OF Promotion 1 Medatya ng Mabuting Asal C1 Schooling 1 Transfer of Assignment (7 issuance of Firearm C1 others, pls. specify: APPLICANT'S INFORMATION: (Please PRINT legibly. Write N/A if not applicable) 1 Name of Badge No. Applicant: Rank Sumame First Name Middle Name 2. Place of Assignment: Contact No.- 3. Present Address: 4. Date of Birth 5. Civil Status: 5. Name of Spouse, If appicable: 1 declare that the answers given above are true and correct to the best of my knowledge and belief. Printed Name of Applicant/ Date Accomplished: Authorized Representative Signature of Applicant) Authorized Representative