Date:

Atty. MARILYN C. ISLA-DE JOYA

Officer-in-Charge
Fiscal Management and Budget Office

SUBJECT: Request for reversal of funds

Greetings!

This is to request the reversal of payment not credited to the JEPS due to
erroneous reference/application numbers. Details are as follows:

Amount paid
Actual assessment ID inputted
Actual reference ID inputted
Date and time of payment
Mode of Payment*

*If payment was made via

Unionbank over-the-counter, please
provide the branch where you
effected the OTC payment.

**If payment was made via UBP bills

payment app, kindly attach the
screenshot of the successful
transaction.

UB reference number

Attached is the proof of payment for your reference.

Sincerely,

NAME OF PAYOR