FORM 4, Annex E Republic of the Philippines

LOCAL GOVERNMENT UNIT

PROVINCE OF SOUTHERN LEYTE
MUNICIPALITY OF SOGOD
SANGGUNIANG KABATAAN COUNCIL

LIST OF BONDED ACCOUNTABLE PUBLIC OFFICER/S

TYPE OF PREVIOUS YEAR'S DATE

REMARKS
APPLICATION
EFFECTIVITY DATE AMOUNT
RISK NUMBER BOND WITH PENDING IF FOUND GUILTY, WHAT
NAME OF PUBLIC OFFICER Check (✓) the DESIGNATION From To COVERAGE ADMINISTRATIVE IS THE STATUS OF THE
appropriate column AND/OR CRIMINAL IMPLEMENTATION
(For Renewal) ACCOUNTABILITY BOND PREMIUM
NEW RENEWAL CASE (Yes or No) OF PENALTY?

TOTAL - - - - ₱ - ₱ -

Prepared by: Certified & Approved by:

Signature over Printed Name Name & Designation of Authorized Official