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57(A) Request for Bonding/Cancellation of Bond

Bureau of the Treasury request form for bonding/cancellation of bond of accountable officials and employees of the Republic of the Philippines

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GENERAL FORM NO.

(Bureau or Office)
Risk Number

(City or Province)

REQUEST 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 BE CANCELLED

Surname
Given
3. DATE OF INCOMING OFFICER ASSUMES ACCOUNTABILITY

Year
4. STATION

2. DESIGNATION OR TITLE OF POSITION

Middle

Month

Day

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

₱
Amount
a) Public Funds
(1) As Collecting Officer
(2) As Disbursing Officer

₱
₱

b) Public Property
(1) Supplies and Materials
(2) Equipment
(3) Others

When extent or character of an Officer's control
over funds or property cannot be inferred from the title
or designation given, a full and complete statement of
duties should be given above.
(Use additional sheet if necessary)

₱
₱
₱

6. SALARY ATTACHED TO THE POSITION

c) Forms and Other Valuables
(1) Internal Rev. Stamps
(2) Internal Rev. Doc. Stamps
(3) Customs Doc. Stamps
(4) Postage and Other Stamped Stock
(5) Science Stamps
(6) Cash Tickets
(7) Others

₱
(In case of temporary appointment or designation,
salary of permanent and temporary incumbent should
be stated)

₱
₱
₱
₱
₱
₱
₱

Total Amount:

7. BOND RECOMENDED

₱
8. BOND FIXED BY LAW OR BY THE CHAIRMAN
COMMISSION ON AUDIT

₱

₱

PERSONAL RECORD OF PERSON TO BE BONDED
(Use additional or separate sheet if necessary)
9. (A) PREVIOUS EXPERIENCE

(B) CRIMINAL OR ADMINISTRATIVE RECORD

(THIS BLOCKED TO BE FILLED ONLY IN CASE OF BOND CANCELLATION)
10. NAME OF OFFICER TO BE RELIEVED

Surname

Given

11. PRESENT TITLE OR DESIGNATION

Middle

12. AMOUNT OF BOND AND RISK NUMBER INFORCE

13. SALARY OF PERSON TO BE RELIEVED

14. DATE OF RELIEF

15. CAUSE OF RELIEF

Year

Month

Day

16. REMARKS

Head of Agency or Office
City Mayor
Provincial Treasurer

}

(Designation)

FIRST INDORSEMENT

GENERAL FORM NO. 57(A)
(Revised March 24, 1976)

,20
Respectfully forwarded, through the Bureau, Provincial or City Auditor,

REQUEST
for
BONDING AND/OR CANCELLATION OF BOND OF
ACCOUNTABLE OFFICIALS AND EMPLOYEES OF THE
REPUBLIC OF THE PHILIPPINES

(NAME)

To the Treasurer of the Philippines, Manila, recommending approval of the
bond proposed in item 7 of the within request.

Head of Agency or Office
City Mayor
Provincial Treasurer

}

(designation)

(DESIGNATION)

SECOND INDORSEMENT
(BUREAU, PROVINCE OR CITY)

,20_____
Respectfully Forwarded to the Treasurer of the Philippines, Manila

.

(DATE TO BE EFFECTIVE)
Bond for the within mentioned position is approved and fixed in the
amount of P ______________________
Cancellation of the bond of M
in the amount of P __________________

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

under Risk No. ___________________is hereby noted.
By Authority of the
CHAIRMAN, COMMISSION ON AUDIT
(Bureau, City, Provincial, Agency,
Corporate Auditor)
 
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