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DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
CITIZEN'S CHARTER SERVICE REQUEST FORM
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SERVICE TITLE: ISSUANCE OF DEPARTMENT AUTHORIZATION TO UTILIZE
ADDITIONAL CONFIDENTIAL FUNDS OF LGUS
REFERENCE NO.__________________________________
CF-R9-RM-YYYY-MM-DD-NO.
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DATE OF REQUEST
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NAME OF CLIENT/ORGANIZATION:
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Documentary RequirementsKindly Check the documents Needed
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CONTACT DETAILS:
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1. Duly approved Three-Year Peace and Order and Public Safety Plan
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OTHER NEEDED INFORMATION, if any:
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Region: Amount Being Requested:
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2. Local Peace and Order Council Resolution duly approved by two-thirds (2/3) of the total membership approving the release and use of additional CF
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Total Peace and Order Program:
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30% Peace and Order Program:
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3. Certification from the concerned PNP Chief of the locality relative to the peace and order situation highlighting in concrete details the circumstances which require the urgency in allocating confidential activitiesSIGNATURE:
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4. Annual and Supplemental Appropriations Ordinance indicating the appropriations for CFRECEIVED BY:DATE AND TIME RECEIVED
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5. Certification from the Local Budget Officer as to the availability of appropriations
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6. Statement of itemized POP duly certified by the Local Budget Officer
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7. Certification of compliance with the Full Disclosure Policy posting requirement in at least three (3) conspicuous places for the last 2 quarters, duly signed by the DILG Field Office concerned and noted by the DILG Regional Director and attested by the CSO Representative
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ENDORSED TO RESPONSIBLE OFFICER:DATE AND TIME ENDORSED
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Name/Unit and Designation
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8. Physical and Financial Plan, for both the original allocation for CF and the subject request, indicating the proposed amount allocated for each program, activity and project
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REMARKS:
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ACKNOWLEDGEMENT RECEIPT
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This is to acknowledge the service/s you have requested:
REFERENCE NO.
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SERVICE TITLE:Date ReceivedExpected Date of ReleaseDate of Release in case of extension



Republic of the Philippines
DEPARMENT OF THE INTERIOR AND LOCAL GOVERNMENT

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NAME OF RESPONSIBLE OFFICER/UNIT/DESIGNATION:CONTACT DETAILS:
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OFFICE ADDRESS: ______________________________________________________________________________________________________________________________________________________________________________________________________
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REMARKS:
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