Annex B

Republic of the Philippines

Commission on Audit
Professional and Institutional Development
Sector
PROFESSIONAL DEVELOPMENT OFFICE
Commonwealth Ave., Constitution Hills, Quezon City
Telefax: 931-7847; 951-0931
e-mail address: pds.tstd@coa.gov.ph

PIDS Form No. Date:

Rev: Dec 2012 CLEARANCE FORM
Course Title:

We are requesting clearance for the attendance of the following Level____employees to the LTP course indicated
above. Pls. check the preferred course schedule for each employee most convenient to the work plan of the
cluster/audit group. Should an employee listed herein no longer belong to this level, please indicate herein.
NAME SCHEDULE SCHEDULE SCHEDULE SCHEDULE
(PERIOD) (PERIOD) (PERIOD) (PERIOD)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
CONFORME:
Cluster/Region/Office Director

_____________________________
Signature over Printed Name

_____________________________
Designation
Cluster/Region/Office Tel. Nos.:_______________
______________________

Cluster/Region/Office Address: Fax Nos.:_______________

_______________________
e-Mail Address:

FOR PIDS USE ONLY

(Action on Nomination)

ACTION TAKEN/ ENTERED IN DATA BASE

REMARKS_______________________________________
________________________________________________ BY _________________________________________
DATE ___________ DATE ______________________