CS Form No.

4
Series of 2017

Republic of the Philippines

Philippine National Police

CERTIFICATION OF ASSUMPTION TO DUTY

This is to certify that ____________________________________ has assumed

the duties and responsibilities as _________________________________ at the
_______________________________________effective __________________.

This certification is issued in connection with the issuance of the promotional

appointment of __________________________ as ____________________________.

Done this ____ day of _________________ in _______________________.

_________________________
Head of Office/Department/Unit

Date: ________________

Attested by:

_________________________
Highest Ranking HRMO

201 File For submission to CSCFO

Admin within 30 days from the
COA
CSC
date of assumption of the
appointee