Annex

Republic of the Philippines

Commission on Audit
PROFESSIONAL and INSTITUTIONAL DEVELOPMENT
SECTOR
Commonwealth Ave., Constitution Hills, Quezon City

Telefax: 931-7847; 951-0931

e-mail address: pds.tstd@coa.gov.ph

PDS Form No.

Rev: Jan 2004

NOMINATION FORM

Course Title:
Date Covered:

Date Filed:
July 25, 2014

Writing the AOM and the Annual Audit Report

November 18 21, 2014

WE ARE NOMINATING THE FOLLOWING TO THE ABOVE-NAMED COURSE:

NAME
POSITION
REMARKS
1. Sheryhan M. Lucman
State Auditor I
2.
3.
4.
5.
6.
7.
8.
9.
10.
Head of Office/Agency:
ADELINA CONCEPCION L. ANCAJAS
Signature over Printed Name
Director Cluster 2, NGS
Designation
Office/Agency: COA BIR RR6, CLUSTER 2, NGS
Office Address: Solana Street, 1002 Intramuros, Manila

Tel. Nos.:
567 - 3995
Fax Nos.:_______________

e-Mail Address:
FOR PIDS USE ONLY
(Action on Nomination)
NOMINATIONS:
CONFIRMED
NOT CONFIRMED

SEMINAR:
CANCELLED
DEFERRED, NEW DATE____________________

Professional Development Office

(Authorized Official)

(For agency personnel, please read guidelines at the back of this form)

Integrity, Commitment, and Competence in the Commission

Annex 3
Page 2

BACKGROUND INFORMATION
As of MAY 27, 2013
A. PERSONAL DATA:
Name:

Nickname:

Birthday:

Position/Designation

Years in Position:

Age/Sex/Status:

Office/Agency: COA-BIR CLUSTER 2/NGS

Fax Nos.: 981-7490

Education (Degree Earned)

Office Address: BIR Natl Office, Agham Rd.,

Diliman, Quezon City
e-mail address:
Home Address:

Telephone: 926-5674

School:

Telephone:
Cel Number:

Special Dietary Requirements

Other Remarks:

Strict vegetarian
Vegetarian

No beef please
No pork please

Physically Challenged

B. PRESENT FUNCTIONS/DUTIES/RESPONSIBILITIES:

C. TRAININGS ATTENDED FOR THE PAST THREE (3) YEARS:

Course Title

Inclusive Dates

Place/Venue

(Please reproduce this page if needed)

Integrity, Commitment, and Competence in the Commission