ANNEX “D”

Name of Sector/Region
Name of Office

____________________
(Date)

Director ______________________
Civil Service Commission
Regional Office No. 3
San Fernando, Pampanga

Dear Director________________:

We respectfully refer the letter/complaint dated_________________ of

Mr./Ms.____________ who imputes commission of acts allegedly in violations of laws,
rules and regulations (or state the specific allegations) against the officials and/ employees
of the Provincial Government of _________. The resolution of the allegations appears to
be within the jurisdiction of your office, hence, this referral.

Accordingly, please direct to Mr./Ms. ______________ any action on his/her

letter/complaint, copy furnished this Office.

Thank you.

Very truly yours,

_____________________
Director IV
Cluster/Regional Director

Copy furnished:

Mr./Ms._____________________
Address
(If not anonymous)

*The body may be modified but letter should have the same tenor.