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Republic of the Philippines

Region III, San Fernando, Pampanga

Mr. X, Appellant Appeal from Notices of Disallowance

(ND) Nos. ______, dated __________,
with an aggregate amount of


Mr. Y, Audit Team Leader for

Water District in the Province
of______, and Mr. Z, the
Supervising Auditor for the
Water Districts Audit Group,



APPELLANTS, to this Honorable Office, most respectfully submit this Appeal Memorandun, viz:

I. Preliminary Statement

This is an appeal on the COA Notice of Disallowance No. ______________ dated ________, issued
by ________________________, against _(appellant)__ on the ____(payment of various benefits to the
officials and employees of the)____.

II. Facts of the Case

(state the facts of the case such as:

 Names and other circumstances of the parties

 Nature of the transaction
 Date when the ND was received)

III. Issues

The following arguments were offered by the Appellant:

a. (Whether or not the payment of benefits and allowances to _______ be allowed in audit);

IV. Discussion

(state related laws allowing the grant of benefits/allowances)

V. Relief

ACCORDINGLY, premises considered, it is most respectfully asked that this Honorable Office
REVERSE and/or SET ASIDE Notice of Disallowance No. _______ dated _________.

Other relief just and equitable under the premises are likewise prayed for.

City of ________________, ____________, Philippines, March xx, _______.)

Sgd. Mr. X