__ _____ 2012

TO : (Name of Employee)
(Position)

FROM: (Name of Office or Department)

RE : NOTICE TO EXPLAIN

Please be informed that you have been reported to have committed the following
infractions against (Name of Company) (the “Company”):

1. ______________________;

2. _____________________; and

3. _______________________.

Kindly take notice that the foregoing are violations of the Company policies and clear
acts of insubordination which are valid grounds for suspension and/or termination

In view of the foregoing, the Company is giving you ____ (__) days from receipt of this
memorandum to submit a written explanation why no disciplinary action should be
imposed against you. Failure to submit your written explanation and reports within the
prescribed period shall mean waiver of your right to be heard and present your side,
and entitle the Company to decide the matter based on the records on hand.

Furthermore, you are hereby placed under PREVENTIVE SUSPENSION effective

immediately and for a period of ______ (__) days while this matter is being investigated.

Please be guided accordingly.

Prepared by:

___________________

Noted by:

_______________

Received : _______________
Date : _______________
Time : _______________