Republic of the Philippines

Department of Justice
PAROLE AND PROBATION ADMINISTRATION
National Capital Region
QUEZON CITY PAROLE AND PROBATION
OFFICE NO. 1
Basement, Hall of Justice, Quezon City

INSTRUCTION TO PROBATIONERS P.A. FORM NO. 4

NAME: ______________________________PROBATION NUMBER: ______________

COURT No. ____________ PROBATION DATE: ______________

With these instructions you are receiving a copy of the court order.
/ / GRANTING PROBATION
/ / MODIFYING PROBATION
/ / CONTINUING PROBATION
Only the court has the authority to charge any of the conditions required:
1. To notify the probation officer regarding changes of you address or employment.
2. To remain in your municipality or city of residence unless permitted by the court or
probation officer to go elsewhere. Request to change address should be filed in one
month in advance and request for outside travel should be filed at least five-working
days prior to date of departure.
3. To report to the probation officer in person as directed. The office is closed
Saturdays, Sundays, and Holidays.
4. To obey all laws.
5. To follow other directions pertaining to the program of your probation.
If your whereabouts become unknown to your probation officer because of your failure to keep
him informed, the court may order your arrest. Any failure by you to comply with all the terms
and conditions of probation will mean that the Court can revoke your probation and sentence
you to prison or change or add to the terms of probation.

CERTIFICATION
I, __________________________________, hereby declare that the foregoing terms and
conditions of probation have been explained to me and I fully understand them and agree to
abide with them in everyday.

Signed this _______ day of ________, 2023 at Quezon City, Philippines.

______________________________
Probationer
ATTESTED BY:

GIRLIEZETTE U. PALACIO
Chief Probation and Parole Officer