REPUBLIC OF THE PHILIPPINES GENERAL FORM No.

57(A)
___________________________________________ (Revised March, 1976)
Bureau or Office
RISK NUMBER
LGU-IPIL, ZAMBOANGA SIBGUAY
City or Province
REQUESTING FOR BONDING AND/OR CANCELLATION OF BOND OF
ACCOUNTABLE OFFICIALS AND EMPLOYEES OF
THE REPUBLIC OF THE PHILIPPINES
1. NAME OF PERSON TO BE BONDED/WHOSE BOND IS TO 2. DESIGNATION OR TITLE OF POSITION
BE CANCELLED

Surname Given Middle

3.DATE INCOMING OFFICER ASSUMES ACCOUNTABILITY

Year Month Day

4.STATION

Municipality Province/City
5.AMOUNT OF MAXIMUM ACCOUNTABILITY/CUSTODY

AMOUNT When extent or character of an officer's control

(a) Public Funds over funds or property cannot be inferred from the
(1) As Collecting Officer P title or designation given, a full and complete statements
(2) As Disbursing Officer P of duties should be given above.
(Use additional sheet if necessary)
(b) Public Property
(1) Supplies & Materials P 6, SALARY ATTACHED TO THE POSITION
(2) Equipment P
(3) Others P
© Forms and other valuables (In case of tenporary appointment r designation, salary
(1) Internal Rev. Stamps P or permanent and temporary incumbent should be stated)
(2) Internal Rev. Doc. Stamps P 7. BOND RECOMMENDED
(3) Customs Doc. Stamps P
(4) Postage & Other Stamped Stock P
(5) Science Stamps P 8. BOND FIXED BY LAW OR BY THE CHAIRMAN, COMMISSION
(6) Cash Ticket P ON AUDIT
(7) Others P
Total Amount
PERSONAL RECORD OF PERSON TO BE BONDED
(Use additional or separate sheets if necessary)

9. (A) PREVIOUS EXPERIENCE (B) CRIMINAL OR ADMINISTRATIVE RECORD

(THIS BLOCK TO BE FILLED ONLY IN CASE OF BOND CANCELLATION)

10. NAME OF OFFICER TO BE RELIVED 11. PRESENT TITTLE OR DESIGNATION

Surname Given Middle

12. AMOUNT OF BOND AND RISK NUMBER IN FORCE 18. SALARY OF PERSON TO BE RELIEVED

14. DATE OF RELIEF 15. CAUSE RELIEF

DAY
16. REMARKS

Head of Agency or Office ANAMEL C. OLEGARIO

City Mayor Municipal Mayor
Provincial Treasurer
 FIRST INDORSEMENT
____________,20_____________

GENERAL FORM No. 57 (A) Respectfully forwarded, through the Bureau,

(Revised March 24, 1976) City Auditor,

REQUEST
for to the Treasurer of the Philippines, Manila, recommending
BONDING AND/OR CANCELLATION OF BOND OF approval of the bond in item 7 of the within request.
ACCOUNTABLE OFFICIALS AND EMPLOYEES OF THE
REPUBLIC OF THE PHILIPPINES
Bureau Director
City Treasurer of LOLITA J. INOFERIO
Provincial Treasurer Municipal Treasurer

NAME
SECOND INDORSEMENT
____________,20_____________
DESIGNATION Respectfully forwarded to the Treasurer of the
Philippines Manila.

BUREAU, PROVINCE or CITY Bond for the within-mentioned position is approved and
fixed in the amount of P _________________________________

DATE TO BE EFFECTIVED Cancellation of the Bond of M_______________________

_______________________in the amount of P_______________
under Risk No. ______________________is hereby noted.

(Brief to be filled in by the Treasurer of the Philippines)

CHAIRMAN, COMMISSION ON AUDIT

(Bureau, City, Provincial, Agency

Corporate Auditor)
 General Form No. 58(A)
(Revised March 24, 1976)
REPUBLIC OF THE PHILIPPINES
___________________

APPLICANTS FOR BOND OF ACCOUNTABLE OFFICIALS AND EMPLOYEES OF THE

REPUBLIC OF THE PHILIPPINES
______________________

I ___________________________________________of ________________________________________________
hereby apply for bond as a _______________________________________________________in the service of
(Bondable Position)
__________________________________________at ___________________________________________________________
(Name of Office, Bureau of Government-Owned or controlled corporations)
Province of __________________________________________________________________________________________

APPLICANTS TO HOLD BONDABLE POSITIONS MUST ANSWER ALL QUESTIONS IN FULL

(ALL REPLIES CONFIDENTIAL)

1. Place and date of birth

2. Civil Status: Single, Married, or Widower/Widow
How many persons are dependent on you for suport?
3. What salary will you receive?
4. Have you any income othe than your salary? If so, how much, and and from what sources derived

5. If engaged in any other business, give particulars and names of partners or associates, if any

6. Indicate Tax Account Number _________________________, attach latest statements of Assets and Liabilities.
7. Name three references

8. Have you ever been discharge from anay position?if so, state particulars

9. Do you carry life insurance? If so, how much, in what company, and to whom payable?

10. Have you ever applied before fro bond from any fidelity and guaranty company? If so, when and where?

11. Do you have any criminal or administrative records?___________________________If so, state briefly the nature
thereof
12. Are you a member of any fraternal, social or political society? State the name and nature of each society.

13. What is the estimated total amount of all the monthly living expenses of yourself and family?

The answers to the foregoing questions are true to the best of my knowledge and belief, and in witness whereof,
I affix my signature below, this__________________________day of___________________________20_____________

IN THE PRESENCE OF:

_________________________________ ________________________________
Witness Signature of Applicant

SUBSCRIBED AND SWORN TO before me this______________day of _______________,20_______________________

The applicant presented to me this his/her residence Certificate No.A_________________issued at________________
_____________________________________________________on ___________________________,20_________________<

Doc No._______________
Page No.______________
Book No.______________
Series No. _____________
(Signature of Officer Administering Oath)
General Form No. 58(A) CERTIFICATION OF VERIFICATION
(Revised March 24, 1976) AND OBSERVATION

The following description of the applicant is required to be filled THIS IS TO CERTIFY that I verified the truthfulness of the
and certified by a compotent physician of the Department of Health in Manila or answers to the question contained on the face of this form and
in the provinces. One copy of his bust picture musst be pasted on the space provided found them to be correct in so far as can be ascertained.I further
therefor hereon. certify having inquired into the character, honesty, integrity, and
efficiency of the within applicant ansd found him to be _____
(SPACE FOR PICTURE)
1. Height worthy of trust, confidence and reliance.
2. Weight Hence, the recommendation of the undersigned as expressed
3. Complexion in his 1st Indorsement contained on General Form 57-A to which
4. Face with or without smallpox this Form (General Form 58-A) is attached.
5. Color of eyes
6. Color of hair
7. Color of Mustache
8. Color Beard (Head of Office or Agency)
9. Birth and other marks on the
(A) Face
(B) Body Date _______________________,20_______
(C) Hands
(D) Arms
(E) Legs and Feet

I CERTIFY to the correctness of the foregoing description of _____________

(Name of Physician, Department of Health)

(Official Designation)

, 20_______