Republic of the Philippines Form Number

Department of Finance Effective Date

BUREAU OF THE TREASURY
Intramuros, Manila Date Reviewed

Department/Service: Date Revised

LEGAL SERVICE – COMPLAINTS AND
INVESTIGATION DIVISION Revision Number
Funding the Republic COMMUNITY BACKGROUND
Date of next review
QUESTIONNAIRE

Dear Sir/Madam:

This is in relation with the Character Investigation on new entrants being conducted by this Office
pursuant to Section 26 (1), Chapter 5, Subtitle A, Book V, Executive Order No. 292 series of 1987,
otherwise known as the Administrative Code of 1987, requiring that all persons, following their
original appointment shall undergo a thorough Character Investigation in order to acquire
permanent civil service status.

Relative thereto, we are requesting you to vouch for the personal character of ATTY. JEREKKO
A. CADORNA in view of his/her recent appointment in this Bureau, by sparing us from your
valuable time in answering the following questions. Rest assured that the information disclosed
herein shall be treated with utmost confidentiality.

Name (Pangalan) :_______________________________________

Address (Tirahan) :_______________________________________
Contact Information (Numero) :_______________________________________
Age (Edad :_______________________________________
Work (Trabaho) :

1. How long have you known the aforementioned person? (Gaano mo nang katagal kakilala ang
taong nabanggit?)
_________________________________________________________________
2. What is your relationship with the aforementioned person? (Ano ang iyong kaugnayan sa taong
nabanggit?)
___________________________________________________________________________
___________________________________________________________________________

3. Based on your personal knowledge, has he/she ever been complained, arrested, or indicted for
any violation of law? If yes, please give details. (Sa iyong pagkakaalam, ang tao bang nabanggit
ay nasampahan ng reklamo, naaresto o nasakdal dahil sa paglabag ng batas? Kung oo, maari
mo bang ibigay ang mga detalye tungkol dito.)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

4. Based on your personal knowledge, does he/she have any vice(s) such as: drinking,
smoking, use of illegal drugs, gambling, etc.? If yes, please give details. Sa iyong pagkakaalam,
ang tao bang nabanggit ay mayroong bisyo katulad ng pag-inom ng alak, paninigarilyo, paggamit
ng ipinagbabawal na gamot, pagsususgal o iba pa? Kung oo, maari mo bang ibigay ang mga
detalye tungkol dito.)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
 Republic of the Philippines Form Number
Department of Finance Effective Date
BUREAU OF THE TREASURY
Intramuros, Manila Date Reviewed

Department/Service: Date Revised

LEGAL SERVICE – COMPLAINTS AND
INVESTIGATION DIVISION Revision Number
Funding the Republic COMMUNITY BACKGROUND
Date of next review
QUESTIONNAIRE

5. Please describe how the aforementioned person interacts with his/her neighbors and the
community he/she lives in? (Maaari mo bang ilarawan kung paano makitungo ang taong
nabanggit sa inyong mga kapitbahay at sa komunidad na kanyang kinabibilangan?)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

6. Please provide us other details about the aforementioned person that is deemed useful in this
Character Investigation? (Maaari ka bang magbigay ng iba pang detalye tungkol sa taong
nabanggit na makatutulong sa imbestigasyon na ito.)
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

I hereby attest to the truth of all the foregoing.

Signature over printed name Date

(Lagda sa ibabaw ng pangalan) (Petsa)

PLEASE RETURN QUESTIONNAIRE TO:

BUREAU OF THE TREASURY

Ayuntamiento Building
Cabildo Street corner A. Soriano Avenue
Intramuros, Manila 1002

ATTN: ATTY. WILLIAM A. BELUSO, JR. CESO IV

Director III, Legal Service
Bureau of the Treasury

THANK YOU FOR KIND ASSISTANCE