LAELEP FORM No.

1
Revised 2006
LEGAL ASSISTANCE FOR EFFECTIVE LAW
ENFORCEMENT PROGRAM (LAELEP)
IBP BLDG., New Capitol Site, Tagbilaran City

APPLICATION FORM

I, ____________________________________________________________________________, of
legal age, married/single, a resident of __________________________________________________, but
presently assigned at _______________________,PNP Station, hereby apply for Legal Assistance under the
provisions of the LAELEP and I hereby certify that all statements that I make herein are true according to my
personal knowledge, with the understanding that the IBP-Bohol Chapter, through the LAELEP, could initiate
the filing of an administrative case against me on the ground of DISHONESTY, should any of the following
statements be truthful:
1. This request for Legal Assistance is made for the purpose of defending me in the case/s filed
against me with following particulars:
a. Plaintiff/Complainant:_____________________________________________________
b. Case No.:______________________________________________________________
c. Title:__________________________________________________________________
d. Court/Office:____________________________________________________________
2. I hereby declare that the case/s referred to in No. 1 hereof is a COUNTER-CHARGE to the case/s OR
a case filed in relation to the acts & committed while enforcing laws or maintaining peace and
order and while on official duties, now pending against herein complainant/plaintiff with the
following particulars:
a. Plaintiff/Complainant:_____________________________________________________
b. Case No.:_______________________________________________________________
c. Court/Office:____________________________________________________________
d. Title:__________________________________________________________________
3. That my participation in connection with the case/s referred to in No. 2 hereof was in connection
with the performance of my official duties, stated as follows (EX: arresting and/or searching and
seizing officer, investigating officer, filed the complaint/s against herein complainant/plaintiff,
witness, etc):
__________________________________________________________________________
4. I attached hereto copies of the documents in connection with the cases filed against herein
complainant/plaintiff AND the case/s filed herein complainant/plaintiff against me, as follows:
a.________________________________________________________________________
b.________________________________________________________________________
c.________________________________________________________________________

5. I will abide with the TERMS and CONDITIONS imposed by the LAELEP as conditions for my coverage
under the Program.

Date:_________________________ Signature of Applicant__________________________

ACTION TAKEN:

(Granted or Denied: If denied, screening member shall give reason/s thereof)

______________________________________
(Signature of Screening Member and date when the action is taken)

_____________________________________________________________
(Whether Approved or Disapproved)

______________________________________
(Signature of Chairperson/President and date when the action is taken)