Authority To Deduct

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REPUBLIC OF THE PHILIPPINES)

………………………… ) S. S.

AFFIDAVIT OF AUTHORIZATION TO DEDUCT

I, ____________________________________, of legal age, Filipino, and with a postal


address at ___________________________________________________________
after having duly sworn to in accordance with law do hereby depose and state:

That, I am the legal wife/beneficiary of _____________________________________,


(Name of PNP Personnel)
formerly assigned at __________________________________;

That, _________________________________________ Compulsorily/Optionally


(Name of PNP Personnel)

Retired/Separated from the PNP Service effective ___________________ pursuant to


S.O./G.O. Number __________ dated _______________________;

That, prior to his/herseparation, he/she has an outstanding Loan Balance from the
PNP Provident Fund/Firearms Accountability/Salary Overpayment amountingto
P____________;

That, in view with the above______________________________________________,


(Loan Balance from PNP Provident Fund/Firearms Accountability/Salary Overpayment)
I am authorizingthe Retirement Claims and Funds Management Division (RCFMD) and/or
Pension and Gratuity Division (PGD) of PNP Retirement and Benefits Administration Service
(PRBS) to deduct said amount from my Commutation of Accumulated Leave (CAL) claims
and/or Lump Sum/Retirement Gratuity claims;

That, I am executing this Affidavit to the truthfulness of the foregoing facts and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ________ day of


_________ 20___ at _____________________________________, Philippines.

_______________________________
Signature over Printed Name
(Affiant)

SUBSCRIBED AND SWORN to before me this ________ day of ____________,


20____ at _______________________________, Philippines.

Doc No. _________


Page No. _________
Book No. _________
Series No. _________

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