Republic of the Philippines GENERAL FORM NO.

57(A)
(Revised March 24, 1976)
Barangay Francisco Homes – Narra
(Bureau or Office)

Risk Number
San Jose Del Monte, Bulacan
(City or Province)

REQUEST FOR BONDING AND/OR CANCELLATION OF BOND OF

ACCOUNTABLE OFFICIALS AND EMPLOYEES OF THE
REPUBLIC OF THE PHILIPPINES
1. NAME OF PERSON TO BE BONDED/WHOSE BOND IS TO BE CANCELLED 2. DESIGNATION OR TITLE OF POSITION

Surname Given Middle

3. DATE OF INCOMING OFFICER ASSUMES ACCOUNTABILITY

Year Month Day

4. STATION

Municipality Province/City
5. AMOUNT OF MAXIMUM ACCOUNTABILITY/CUSTODY

₱
When extent or character of an Officer's control
Amount over funds or property cannot be inferred from the title
a) Public Funds or designation given, a full and complete statement of
(1) As Collecting Officer ₱ duties should be given above.
(2) As Disbursing Officer ₱ (Use additional sheet if necessary)

b) Public Property 6. SALARY ATTACHED TO THE POSITION

(1) Supplies and Materials ₱
(2) Equipment ₱ ₱
(3) Others ₱
(In case of temporary appointment or designation,
c) Forms and Other Valuables salary of permanent and temporary incumbent should
(1) Internal Rev. Stamps ₱ be stated)
(2) Internal Rev. Doc. Stamps ₱ 7. BOND RECOMENDED
(3) Customs Doc. Stamps ₱
(4) Postage and Other Stamped Stock ₱ ₱
(5) Science Stamps ₱
(6) Cash Tickets ₱ 8. BOND FIXED BY LAW OR BY THE CHAIRMAN
(7) Others ₱ COMMISSION ON AUDIT

Total Amount: ₱ ₱

PERSONAL RECORD OF PERSON TO BE BONDED

(Use additional or separate sheet if necessary)
9. (A) PREVIOUS EXPERIENCE (B) CRIMINAL OR ADMINISTRATIVE RECORD

(THIS BLOCKED TO BE FILLED ONLY IN CASE OF BOND CANCELLATION)

10. NAME OF OFFICER TO BE RELIEVED 11. PRESENT TITLE OR DESIGNATION

Surname Given Middle

12. AMOUNT OF BOND AND RISK NUMBER INFORCE 13. SALARY OF PERSON TO BE RELIEVED

14. DATE OF RELIEF 15. CAUSE OF RELIEF

Year Month Day

16. REMARKS

}
Head of Agency or Office
City Mayor
Provincial Treasurer
} (Designation)
GENERAL FORM NO. 57(A) FIRST INDORSEMENT
(Revised March 24, 1976) ,20

Respectfully forwarded, through the Bureau, Provincial or City Auditor,

REQUEST
for
BONDING AND/OR CANCELLATION OF BOND OF
ACCOUNTABLE OFFICIALS AND EMPLOYEES OF THE To the Treasurer of the Philippines, Manila, recommending approval of the
REPUBLIC OF THE PHILIPPINES bond proposed in item 7 of the within request.

}
Head of Agency or Office
(NAME) City Mayor
Provincial Treasurer (designation)

(DESIGNATION)
SECOND INDORSEMENT

(BUREAU, PROVINCE OR CITY) ,20_____

Respectfully Forwarded to the Treasurer of the Philippines, Manila

. (DATE TO BE EFFECTIVE)

Bond for the within mentioned position is approved and fixed in the
amount of P ______________________

Cancellation of the bond of M

(Brief to be filled in by the Treasurer of the Philippines in the amount of P __________________
under Risk No. ___________________is hereby noted.

By Authority of the
CHAIRMAN, COMMISSION ON AUDIT

(Bureau, City, Provincial, Agency,

Corporate Auditor)