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NAP Form No. 3 Accomplish in 3 copies
Revised 2012
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NATIONAL ARCHIVES OF THE PHILIPPINES
Pambansang Sinupan ng Pilipinas

REQUEST FOR AUTHORITY TO DISPOSE OF RECORDS		AGENCY NAME:
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ADDRESS:
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DATE:TELEPHONE NUMBER:
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GRDS/ RDS ITEM NO.RECORD SERIES TITLE AND DESCRIPTIONPERIOD COVEREDRETENTION PERIOD AND PROVISION/S COMPLIED (If Any)
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LOCATION OF RECORDS:VOLUME IN CUBIC METER:
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PREPARED BY: (Name & Signature)POSITION:
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CERTIFIED AND APPROVED BY:
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This is to certify that the above mentioned records are no longer needed and
not involved nor connected in any administrative or judicial cases.
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Name and Signature of Agency Head
or Duly Authorized Representative
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