REPUBLIC OF THE PHILIPPINES

REGIONAL TRIAL COURT

_________ Judicial Region
Branch ______
Cebu City

PEOPLE OF THE PHILIPPINES

Plaintiffs, Crim. Case No. _____________

-versus- For:

____________________________
Accused.
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APPLICATION FOR PROBATION

The undersigned accused, _______________________________ hereby

applies for probation under the provisions of Republic Act No. 10707, as
amended, and states:

1. That he/she is of legal age and a resident of __________________

___________________________________________________________;

2. That on ______________ he/she has been convicted of

_________________________________________ and sentenced to serve
the term of imprisonment of not more than six (6) years and one (1) day;

3. That the crime for which he/she was convicted is not an offense against
the security of the state;

4. That he/she has not previously been convicted by final judgment of any
offense punished by imprisonment of not less than six (6) month and one
(1) day and/or fine of not less than one thousand pesos (P1,000.00); and

5. That he/she has not been on Probation under the provision of R.A. 10707,
as amended.

Signed on ______________ at Cebu City, Cebu, Philippines

__________________________
Signature of Applicant

Assisted by:

Counsel for the Applicant