Republic of the Philippines

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT

BUREAU OF JAIL MANAGEMENT AND PENOLOGY
NATIONAL HEADQUARTERS OFFICE
144 Juco Randa Bldg., Mindanao Avenue, Quezon City

TO

Director, BJMP
(Attn: C, Finance Service)

SUBJECT

Class E Allotment

DATE

: __________________________

1. This is to request for Class E Allotment to __________________________________ ,

(Name of Assignee)
Relationship
: __________________________________
Address
: ______________________________________________
______________________________________________
Amount
: __________________________________
Start Date
: __________________________________
2. It is understood that I will immediately notify the Chief, Finance Service thru channel of
all changes in my status and/or assignment from time to time.
3. The following are three (3) specimen signature of the assignee.
1.________________________ 2._________________________3.________________________
4. The reason for filling this application is/are ____________________________________
_______________________________________________________________________ .
5. I hereby certify that my wife and/or dependents and I are not living together in our
conjugal above due to _____________________________________________________.
6. I certify further that the foregoing is true and correct.
NOTE: Please check your references
in the release of check.
1.______ Thru RFSU __________
2.______ To be pick-up at BJMP-FS by the assignee

_________________________
(Signature over Printed Name)
__________________________
(Unit Code & Account Number)

C E R T I F I C AT I O N
THIS IS TO CERTIFY that an inquiry or investigation was conducted regarding this
request for Salary Assignment of _______________________________________ and found out
that _________________________________ is his/her legal wife, children or dependents.
FURTHER CERTIFY that all entries in this application are true and correct and I
recommend its approval.
Supporting Documents
a) Latest Payslip
b) BJMP ID Xerox Copy (Back to back)

______________________________
(Dir for I & I)