Form 57A

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Republic of the Philippines GENERAL FORM NO.

57(A)
(Revised March 24, 1976)
Bureau of the Treasury
Risk Number
ILOCOS NORTE

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 2. DESIGNATION OR TITLE OF POSITION
AGRESOR RONIE RAMORAN
Surname Given Middle
3. DATE OF INCOMING OFFICER ASSUMES ACCOUNTABILITY
PUNONG BARANGAY
2019 DECEMBER 15
Year Month Day
4. STATION # 33 CABAYO
VINTAR ILOCOS NORTE
Municipality Province/City
5. AMOUNT OF MAXIMUM ACCOUNTABILITY/CUSTODY

₱ 152,148.16
When extent or character of an Officer's control
Amount over funds or property cannot be inferred from the title
a) Public Funds or designation given, a full and complete statement of
(1) As Collecting Officer ₱ duties should be given above.
(2) As Disbursing Officer ₱ 152,148.16 (Use additional sheet if necessary)

b) Public Property 6. SALARY ATTACHED TO THE POSITION


(1) Supplies and Materials ₱
(2) Equipment ₱ ₱ 4,000.00
(3) Others ₱
(In case of temporary appointment or designation,
c) Forms and Other Valuables salary of permanent and temporary incumbent should
(1) Internal Rev. Stamps ₱ be stated)
(2) Internal Rev. Doc. Stamps ₱ 7. BOND RECOMENDED
(3) Customs Doc. Stamps ₱
(4) Postage and Other Stamped Stock ₱ ₱ 100,000.00
(5) Science Stamps ₱
(6) Cash Tickets ₱ 8. BOND FIXED BY LAW OR BY THE CHAIRMAN
(7) Others ₱ COMMISSION ON AUDIT

Total Amount: ₱ 152,148.16 ₱ 1,500.00

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 11. PRESENT TITLE OR DESIGNATION

Surname Given 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 HON. LARISA C. FORONDA
Provincial Treasurer MUNICIPAL MAYOR
GENERAL FORM NO. 57(A) FIRST INDORSEMENT
(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 To the Treasurer of the Philippines, Manila, recommending approval of the
REPUBLIC OF THE PHILIPPINES bond proposed in item 7 of the within request.

}
RONIE R. AGRESOR Head of Agency or Office
(NAME) City Mayor
Provincial Treasurer (designation)
PUNONG BARANGAY
(DESIGNATION)
SECOND INDORSEMENT
BRGY. # 33 CABAYO VINTAR, ILOCOS NORTE
(BUREAU, PROVINCE OR CITY) ,20_____

DECEMBER 15,2019 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 ______________________

(Brief to be filled in by the Treasurer of the Philippines Cancellation of the bond of M


in the amount of P __________________
under Risk No. ___________________is hereby noted.

By Authority of the
CHAIRMAN, COMMISSION ON AUDIT

(Bureau, City, Provincial, Agency,


Corporate Auditor)
Republic of the Philippines GENERAL FORM NO. 57(A)
(Revised March 24, 1976)

Bureau of the Treasury


Risk Number
ILOCOS NORTE

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 CANCEL2. DESIGNATION OR TITLE OF POSITION


AGRIAM CHRISTOPHER AGUSTIN
Surname Given Middle
3. DATE OF INCOMING OFFICER ASSUMES ACCOUNTABILITY
BARANGAY TREASURER
2019 DECEMBER 15
Year Month Day
4. STATION # 33 CABAYO
VINTAR ILOCOS NORTE
Municipality Province/City
5. AMOUNT OF MAXIMUM ACCOUNTABILITY/CUSTODY
₱ 10,000.00
When extent or character of an Officer's control
Amount over funds or property cannot be inferred from the title
a) Public Funds or designation given, a full and complete statement of
(1) As Collecting Officer ₱ duties should be given above.
(2) As Disbursing Officer ₱ 10,000.00 (Use additional sheet if necessary)

b) Public Property 6. SALARY ATTACHED TO THE POSITION


(1) Supplies and Materials ₱
(2) Equipment ₱ ₱ 2,826.00
(3) Others ₱
(In case of temporary appointment or designation,
c) Forms and Other Valuables salary of permanent and temporary incumbent should
(1) Internal Rev. Stamps ₱ be stated)
(2) Internal Rev. Doc. Stamps ₱ 7. BOND RECOMENDED
(3) Customs Doc. Stamps ₱
(4) Postage and Other Stamped Stoc ₱ ₱ 10,000.00
(5) Science Stamps ₱
(6) Cash Tickets ₱ 8. BOND FIXED BY LAW OR BY THE CHAIRMAN
(7) Others ₱ COMMISSION ON AUDIT

Total Amount: ₱ 10,000.00 ₱ 150.00

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 11. PRESENT TITLE OR DESIGNATION

Surname Given 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
HON. LARISA C. FORONDA
City Mayor
Provincial Treasurer
} HON. LARISA C. FORONDA
MUNICIPAL MAYOR
RM NO. 57(A)
rch 24, 1976)
GENERAL FORM NO. 57(A) FIRST INDORSEMENT
(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 To the Treasurer of the Philippines, Manila, recommending approval of the
REPUBLIC OF THE PHILIPPINES bond proposed in item 7 of the within request.

}
CHRISTOPHER A. AGRIAM Head of Agency or Office
(NAME) City Mayor
Provincial Treasurer (designation)
BARANGAY TREASURER
(DESIGNATION)
SECOND INDORSEMENT
BRGY. # 33 CABAYO VINTAR, ILOCOS NORTE
(BUREAU, PROVINCE OR CITY) ,20_____

DECEMBER 15,2019 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 ______________________

(Brief to be filled in by the Treasurer of the Philippines Cancellation of the bond of M


in the amount of P __________________
under Risk No. ___________________is hereby noted.

By Authority of the
CHAIRMAN, COMMISSION ON AUDIT

(Bureau, City, Provincial, Agency,


Corporate Auditor)

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