ABCDEFGHIJKLMNOPQRSTUVWXYZ
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REPORT OF LOST, STOLEN, DAMAGED OR DESTROYED SEMI-EXPENDABLE PROPERTY
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 ENTITY NAME: BUREAU OF SOILS AND WATER MANAGEMENT
FUND CLUSTER: _____________
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Department/Office: __________________________________________________________________
RLSDDSP No.: ____________
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Accountable Officer: _________________________________________________________________
RSLDDSP Date: ___________
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Designation: __________________________________________________________________________
ICS No.: ____________________
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Police Notified:
Yes
Police Station: _________________
ICS Date: __________________
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No
Date: _____________________________
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Status of Semi-expendable Property: (check applicable box)
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Lost
Damaged
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Stolen
Destroyed
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 Property No. DescriptionAcquisition Cost
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Circumstances:
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 ________________________________________________________________________________________
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 ________________________________________________________________________________________
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 ________________________________________________________________________________________
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 ________________________________________________________________________________________
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I hereby certify that the item/s and circumstances stated above
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are true and correct.
Noted by:
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Signature over Printed Name of the Accountable OfficerSignature over Printed Name of the Accountable Officer
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DateDate
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Government Issued ID: __________________________
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ID No.: _____________________________________________
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Date Issued: _______________________________________
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SUBSCRIBED AND SWORN to be me this _______ day of _______________, affiant exhibiting the above
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government issued identification card.
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Doc. No. __________
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Page No. __________
Notary Public
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Book No. __________
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Series No. __________
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