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(revised as of 06-08-2022)

Attachment 2
Form 4: Annex E
(EDIT YOUR AGENCY LETTER HEAD)

LIST OF BONDED ACCOUNTABLE PUBLIC OFFICERS

Type of Designation
Application (e.g EFFECTIVITY AMOUNT BOND REMARKS
NAME OF PUBLIC New/Renewal Disbursing/ DATE RISK COVERAGE
OFFICER collecting/ FROM TO NO. WITH PENDING IF FOUND GUILTY, WHAT IS
signing ADMINISTRATIVE AND THE STATUS OF THE
ACCOUNTABILITY BOND PREMIUM OR CRIMINAL CASE (YES IMPLEMENTATION OF
officer) (FOR RENEWAL) OR NO) PENALTY

ANICETA S. LAWAG
(Treasurer) √ Disbursing 1,232,582.00 750,000.00 11,250.00 1 without pending
Officer administrative
and criminal case

JENNY R. SABUSAP Signing


(CNSPMC) √ Officer 1,232,582.00 750,000.00 11,250.00 1 without pending
administrative
and criminal case

Prepared by: Reviewed by: Certified and Approved by:

ANICETA S. LAWAG LERIO A. LAMPAYAN LERIO A. LAMPAYAN


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

Date:
1-22-2024

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