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Form 4: Annex E

Republic of the Philippines


Bangsamoro Autonomous Region in Muslim Mindanao
PROVINCE OF TAWI-TAWI
MUNICIPALITY OF MAPUN
BARANGAY OF KOMPANG

LIST OF BONDED ACCOUNTABLE PUBLIC OFFICER/S

TYPE OF APPLICATION
PREVIOUS YEAR'S DATA
AMOUNT PREFERRED
(Check "ü" the DESIGNATION (e.g. EFFECTIVITY DATE BOND
NAME OF PUBLIC OFFICER appropriate column) RISK NO. REMARKS (WITH/WITHOUT PENDING
Disbursing/ COVERAGE
Collecting/Signing Officer)
From To ADMINISTRATIVE AND CRIMINAL CASE)
(1, 2, or 3
ACCOUNTABILITY BOND PREMIUM YEARS)
NEW RENEWAL ( For Renewal)

ADZMIR I. HUNAIN ü Punong Baranagay


WITHOUT PENDING CASE

ARAFAT J. MUSA ü Treasurer


WITHOUT PENDING CASE
XXXXXXXXXXXXXXXXXXXXXXXXXX

Prepared by: Certified and Approved by:

ARAFAT J. MUSA ADZMIR I. HUNAIN


Brgy. Treasurer Punong Barangay
Signature over printed name Name & Designation of Authorized Official

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