public advisory july 6, 2015

CONCHITA CARPIO MORALES

Ombudsman

MESSAGE FROM THE OMBUDSMAN

Consistent with the policy thrust of

the Office of the Ombudsman for 2011 -

2018 to enhance efficiency, effectiveness,

transparency, accountability, credibility,

and responsiveness in the performance of

its mandate and function, an enhanced

Citizen’s Charter is hereby issued to

deliver better public services.

Shortened processing time, streamlined

procedures presented in a user-friendly

information brochure, and a feedback

mechanism designed not only to improve

services but to commend deserving

frontline service personnel are some of the

featured means to exceed the expectations

of the transacting public.

We are mindful that the public deserves

the best service from the Office. We will

endeavor to continue improving our

services toward a meaningful, responsive

and relevant public assistance.

As protectors of the people, we shall endeavor, in cooperation with all

sectors of Filipino Society, to promote integrity and efficiency and high ethical

standards in public service through proactive approaches in graft prevention

and public assistance, prompt investigation of complaints and aggressive

prosecution of cases against government officials and employees.

A truly independent Office run by God-fearing men and women with the

highest degree of competence, honesty and integrity, and effectively serving

as watchdog, mobilizer, official critic, and dispenser of justice for the people it

is constitutionally mandated to protect.

MISSION

VISION

WE, the officials and employees of the Office of the Ombudsman, as

protectors of the people, sworn to serve with utmost responsibility, integrity,

loyalty and efficiency, commit to:

ENDER service to anyone who wants to avail of the services of

our office;

XTEND prompt, courteous, and adequate service without

anticipating any gift or reward;

CHIEVE the highest degree of excellence, professionalism,

intelligence and competence;

ESIST from dispensing undue favors to our relatives and friends,

and from discriminating against the poor and underprivileged; and

EARN to strictly observe these standards by taking corrective

measures on complaints about our service.

PERFORMANCE PLEDGE

!

TABLE OF CONTENTS

Menu of Key Services

Application for Ombudsman Clearance

Request for Assistance (RAS)

Filing of New Complaints

Filing of Pleadings and Submission of

Documents Related to Existing Cases

Request for Copy of Case Documents

Request for Case Information

Request for Copy of Statement of Assets,

Liabilities and Net Worth (SALN)

Redress of Clients’ Complaints and Grievances

Forms

Directory

Page

1

2

6

8

10

11

14

16

18

20

32

Frontline Services FeesHow long will it

take? Where to go?

Reference

Page

1 Application for Ombudsman

Clearance

₱ 100.00 -

1,000.00

70 minutes

if without namesake

3 working days

upon receipt of

payment for

application made in

bulk, thru mail,

courier and online

5 working days if

with namesake or

pending case that

need further

verification and for

application made

thru any authorized

SM Business Center

Ombudsman offices in Quezon

City, Cebu, Iloilo, Tacloban,

Davao, Cagayan de Oro, any

authorized SM Business

Centers and through

www.ombudsman.gov.ph

2-5

2 Request for Assistance (RAS) None 30 minutes Public Assistance Bureau /

Area PACPO

6-7

3 Filing of New Complaints None 15 minutes Records Division/Unit 8-9

4 Filing of Pleadings and

Submission of Documents

Related to Existing Cases

None 8 minutes Records Division/Unit 10

5 Request for Copy of Case

Documents

₱5.00 per page for

plain copy /

₱10.00 per page

for certified copy

40 minutes

for documents not

more than 10 pages

2 working days

for voluminous

documents and for

old cases

Records Division/Unit 11-13

6 Request for Case Information None 25 minutes Records Division/Unit 14-15

7 Request for Copy of Statement of

Assets, Liabilities, and Net Worth

(SALN)

₱5.00 per page for

plain copy /

₱10.00 per page

for certified copy

55 minutes

per person per year

Records Division/Unit 16-17

8 Redress of Clients’ Complaints

and Grievances

None 30 minutes Public Assistance Bureau /

Area PACPO

18-19

MENU OF KEY SERVICES

1

WHO MAY AVAIL OF THE SERVICE?

• Any person may apply personally or through an authorized representative

• Heads of departments, offices, agencies, bureaus or their duly authorized representatives,

with respect to their own personnel or under the terms of an existing Memorandum of

Agreement

• Chairpersons or duly authorized representatives of the Judicial and Bar Council,

Commission on Appointments and other search and selection committees or bodies, as to

their respective applicants/nominees

WHAT ARE THE REQUIREMENTS?

• Duly accomplished Application for Ombudsman Clearance (OMB Form 1) for individual

applicants, personally or through a duly authorized representative together with an

authorization letter stating name of representative and signature of client; or a formal letter-

request addressed to the Ombudsman from requesting government agencies or institutions

for stated purposes specified in OMB Form 1

• Presentation of a valid ID and submission of photocopy of valid ID of representative

• Payment of clearance fees

• Photocopy of the service record may be required for further verification

• Photocopy of Death Certificate for death claim

WHEN TO FILE?

• Any time but not earlier than six (6) months in case of retirement

WHERE TO FILE?

• Ombudsman offices in Quezon City, Cebu, Iloilo, Tacloban, Davao and Cagayan de Oro

• Any authorized SM Business Centers

• Through www.ombudsman.gov.ph

HOW LONG WILL IT TAKE?

• Seventy (70) minutes processing time if without namesake

• Three (3) working days upon receipt of payment for application made thru mail, courier,

or online

• Three (3) working days for application made in bulk

Note: Minimum of ten (10) applicants per day per agency and per authorized

representative

• Five (5) working days if with namesake or pending case that needs further verification

• Five (5) working days for application made thru any authorized SM Business Center

Note: The total processing time is for one client being served at one-time and may vary

depending on the number of applicants availing the service or if the name of the

applicant is a common name and there are voluminous documents to be verified.

APPLICATION FOR

OMBUDSMAN CLEARANCE

2

Step Client Service ProviderResponse

Time

Person in

ChargeFees Forms

1 a. Approaches Receiving

Clerk

b. Fills out and submits

Application for

Ombudsman Clearance

(OMB Form 1)

c. Presents ID, if personally

filed; and if filed by a

representative,

applicant’s ID,

representative’s ID and

authorization letter

d. Receives OMB Form 1 &

1A together with

attachments

a. Greets applicant

b. Gives OMB Form 1 to be filled out by

the applicant

c. Asks applicant to present valid ID and

notes down the ID presented at the

bottom of OMB Form 1

• Examines the accomplished OMB

Form 1 if all fields have been filled

out

• Prepares Clearance Payment Slip

(OMB Form 1A)

d. Gives OMB Form 1A and returns

OMB Form 1 with attachments to the

applicant and directs the applicant to

the cashier to pay the required fees

5 minutes Receiving Clerk

OMB Form 1

OMB Form 1A

OMB Form 1 &

OMB Form 1A

2 a. Goes to cashier to pay

the required clearance

fees

b. Pays the required

clearance fees

c. Receives the Official

Receipt (OR)

a. Gets OMB Form 1A, checks if the

amount tallies with the purpose

b. Receives payment

c. Issues OR and directs the applicant to

return to the Clearance unit to submit

OMB Form 1 and OR

5 minutes Cashier *Refer to

the listing

of

clearance

fee on

page 5

OMB Form 1A

3 a. Returns to Clearance Unit

to submit OMB Form 1

and OR

a. Receives OMB Form 1 and OR

• Checks payment details

• Stamps “RECEIVED” on OMB Form 1

5 minutes Receiving Clerk /

Encoder

HOW TO AVAIL OF THE SERVICE?

3

APPLICATION FOR

OMBUDSMAN CLEARANCE


Time

Person in

ChargeFees Forms

b. Receives Clearance

Claim Slip

(OMB Form 1C)

b. Prepares and gives applicant

OMB Form 1C

• Asks applicant to take a seat until

his/her queue number or name is

called

• Forwards OMB Form 1 to the

encoder

• Encodes applicant’s information in

the database

• Forwards OMB Form 1 to assigned

verifier

• Verifies applicant’s information in

the Complaint and Case Monitoring

System (CCMS)

• Prints Clearance or Certification

• Forwards printed clearance or

certification and OMB Form 1 to

reviewing official

• Reviews print-out and checks

completeness and accuracy of

information in clearance or

certification

• Signs clearance or certification or

returns it to the verifier for

cancellation and re-issuance of

clearance or certification

• Forwards signed clearance or

certification and OMB Form 1 to the

releasing clerk for release

40 minutes

10 minutes

Verifier

Reviewing Official

OMB Form 1C

4 a. Proceeds to releasing

clerk

b. Gives OMB Form 1C

a. Calls queue number or name of

applicant

b. Gets OMB Form 1C of applicant

5 minutes Releasing Clerk

OMB Form 1C

APPLICATION FOR

OMBUDSMAN CLEARANCE

4


Time

Person in

ChargeFees Forms

c. Checks details of

clearance or certification

d. Signs Release

Transmittal Report

e. Receives clearance or

certification

c. Asks applicant to check the

correctness of his/her personal details

in the clearance or certification

d. Affixes dry seal on the clearance or

certification and asks applicant to sign

the Release Transmittal Report

e. Releases clearance or certification

together with the Official Receipt and

reminds client to accomplish and drop

Feedback Form (OMB Form 7) in the

designated box and tells client parting

words, “Have a nice day!”

OMB Form 7

5 Accomplishes and drops

OMB Form 7 in the

designated box

OMB Form 7

END OF TRANSACTION

Schedule of Clearance Fees:

Purpose of ClearanceAmount of Clearance

Fees

Complete Disability Discharge, Death Claim, Disability Retirement, Discharge, Dropped from the Roll, End of

Contract, End of Term, Expiration of Appointment, Expiration of Term, GSIS Claims, Rationalization, Resignation,

Retirement, Reversion, Separation, Total Permanent Physical Disability

₱ 100.00

Appointment, Confirmation, Employment, Foreign Assignment, Grant of Benefits, Lateral Entry, Promotion,

Reappointment, Reemployment, Transfer₱ 150.00

Awards, Bar Exam, CES Eligibility, CESO Rank, Change of Name, Commissionship, Completion of Residency

Training, Court Requirement, Extension of Service, Foreign Travel, Free and Accepted Masonry, Guarantorship,

Leave Application, Loan Application, Nomination, Recognition, Requirement by Agency, Scholarship, Schooling,

Scientific Career System, Study Grant, SUC Presidency, UN Mission, Visa

₱ 200.00

Bidding Requirements, Fidelity Bond, Permit to Carry Firearms ₱ 500.00

Firearms License ₱ 1,000.00

Note: For plain photocopy, ₱ 5.00 per page

For certified copy, ₱ 10.00 per page

5

APPLICATION FOR

OMBUDSMAN CLEARANCE


Time

Person in

ChargeFees Forms

1 a. Approaches Officer-of-the-

Day

b. Receives and accomplishes

Request for Assistance

Form (OMB Form 2)

c. Submits duly accomplished

OMB Form 2 or any

prepared complaint or

request

a. Greets and interviews client to

elicit information about the client’s

concerns, parties and the acts

being complained of

b. Gives client OMB Form 2 to

accomplish

c. Receives and peruses the duly

accomplished OMB Form 2 to

determine if pertinent fields have

been filled in

• Stamps “RECEIVED” if there is

an accompanying letter-request

and attaches it the OMB Form

2 as annex

30 minutes Officer-of-the-Day No

Fees

OMB Form 2


• Anyone who has a legitimate request, grievance, or concern seeking redress,

relief, or public assistance which does not amount to any criminal, administrative or

forfeiture complaint, wherein the Office of the Ombudsman is mandated to

intervene within its powers, functions, and jurisdiction.


• Letter-request/grievance-letter or duly accomplished Request for Assistance Form

(OMB Form 5)


• Thirty (30) minutes


REQUEST FOR ASSISTANCE

6


Time

Person in

ChargeFees Forms

• Takes action or explains the

procedure to be followed in

disposing or acting on the

request

• Reminds client to accomplish

and drop Feedback Form

(OMB Form 7) in the

designated box and tells client

parting words, “Have a nice

day!”

OMB Form 7


OMB Form 7 in the

designated box

OMB Form 7

END OF TRANSACTION


7


• Any aggrieved party

• Representative of the aggrieved party/complainant


• Sufficient number of copies of verified complaint-affidavit and supporting

documents

Note: Number of copies = Number of named respondents + 4 copies

• Verified Certificate of Non-Forum Shopping (CNFS)


• Fifteen (15) minutes



Time

Person in

ChargeFees Forms


Clerk and submits

verified complaint,

supporting documents,

and Certificate of Non-

Forum Shopping

(CNFS)

a. Greets client and receives

verified complaint, supporting

documents, and Certificate of

Non-Forum Shopping (CNFS)

• Checks requirements for

completeness and compliance

with formalities and notes

deficiencies, if any, in the

Complaint Checklist Form for

the information of the

complainant

• Stamps “RECEIVED” on the

copy of the verified complaint

• Forwards all copies of

complaint to the encoder and

advises client to take a seat

5 minutes Receiving Clerk No

Fees

Complaint

Checklist Form

FILING OF NEW COMPLAINT

8


Time

Person in

ChargeFees Forms

b. Takes a seat and waits b. Encodes details of the complaint in

the Complaint and Case Monitoring

System (CCMS) and prints

Acknowledgement Receipt with

Internal Control (IC) Number

8 minutes Encoder

2 Accepts “STAMPED”

receiving copy of the

complaint together with

the printed

Acknowledgment

Receipt with IC Number

Returns receiving copy of the

complaint together with the printed

Acknowledgment Receipt with IC

Number to the client and reminds

client to accomplish and drop

Feedback Form (OMB Form 7) in

the designated box and tells client

parting words, “Have a nice day!”

2 minutes Encoder

OMB Form 7


OMB Form 7 in the

designated box

OMB Form 7

END OF TRANSACTION

9

FILING OF NEW COMPLAINT


Time

Person in

ChargeFees Forms

1 a. Approaches

Receiving Clerk and

submits pleading and

supporting

documents

b. Gets stamped

receiving copy

a. Greets client and receives pleading

• Examines pleading and checks

completeness and compliance with

formalities

• Explains requirements and advises

client to comply, if there are

deficiencies

• Stamps “RECEIVED” on the

pleading

b. Returns stamped receiving copy of the

pleading and reminds client to

accomplish and drop Feedback Form

(OMB Form 7) in the designated box

and tells client parting words, “Have a

nice day!”


Fees

OMB Form 7

2 Accomplishes and

drops OMB Form 7 in

the designated box

OMB Form 7

END OF TRANSACTION


• Any party to the case

• Counsel on record or duly authorized representative of the party


• Two (2) copies of each pleading including its supporting documents

indicating the OMB docket number to be filed

• Proof of service, e.g. original registry receipt or personal service


• Eight (8) minutes


FILING OF PLEADINGS AND SUBMISSION

OF DOCUMENTS RELATED TO EXISTING CASES

10



• Counsel on record

• Authorized representative of the party to the case or counsel


• Duly accomplished Request for Copy of Case Documents (OMB Form 3)

• Presentation of valid ID

• Authorization letter or Special Power of Attorney for representative of the party/counsel


• Forty (40) minutes for documents not more than 10 pages long

• Two (2) days for voluminous documents or old cases



TimePerson in Charge Fees Forms


Clerk

b. Gets and fills out

Request for Copy of

Case Documents

(OMB Form 3)

c. Submits filled out OMB

Form 3, presents valid

ID and takes a seat

a. Greets and interviews client

• Verifies if client is a party to the

case, counsel on record, or

authorized representative;

• Instructs the client to write a

formal letter stating the purpose

of the request if not a party

b. Gives client OMB Form 3 and asks

for a valid ID

c. Examines filled out OMB Form 3

• Asks client to take a seat

• Forwards OMB Form 3 to

records custodian


Fees

OMB Form 3

REQUEST FOR COPY OF

CASE DOCUMENTS

11


Time

Person in

ChargeFees Forms

2 Waits for the requested

documents

Retrieves requested documents

• Photocopies requested documents

• Certifies photocopies as faithful

reproduction of the record on file, if

requested in OMB Form 3

• Prepares Payment Slip (OMB

Form 3A) and writes amount of

fees on OMB Form 3

• Forwards OMB Forms 3, 3A, and

requested documents to the Chief

of Records

• Approves OMB Forms 3 and 3A

• Refers approved OMB Forms 3

and 3A including requested

documents to receiving clerk

25 minutes

1 minute

Records

Custodian

Records Chief

₱5.00 per

page for plain

copy /

₱10.00 per

page for

certified copy

OMB Form 3A

3 Receives OMB Form 3A Gives OMB Form 3A to client and

directs client to the cashier to pay the

required fees

2 minutes Receiving

Clerk

OMB Form 3A

4 a. Goes to Cashier and pays

the required fees

b. Receives Official Receipt

(OR)

c. Returns to the Records

Division to claim the

requested documents

a. Receives payment

b. Issues OR

c. Directs client to the Records

Division to claim the requested

documents

5 minutes Cashier ₱5.00 per

page for plain

copy /

₱10.00 per

page for

certified copy

5 a. Presents OR

b. Signs at the receipt

portion of the OMB Form 3

a. Asks requester to present the OR

and checks if the amount is correct

b. Asks client to sign at the receipt

portion of the OMB Form 3

2 minutes Receiving

Clerk

OMB Form 3

REQUEST FOR COPY OF

CASE DOCUMENTS

12


Time

Person in

ChargeFees Forms

c. Receives requested

documents

c. Releases requested documents to

the client and reminds client to

accomplish and drop Feedback

Form (OMB Form 7) in the



OMB Form 7


OMB Form 7 in the

designated box

OMB Form 7

END OF TRANSACTION

REQUEST FOR COPY OF

CASE DOCUMENTS

13



• Counsel on record

• Authorized representative of the party or counsel


• Duly accomplished Verification Slip (OMB Form 4)

• Presentation of valid ID of client and representative

• Authorization letter or Special Power of Attorney for representative


• Twenty Five (25) minutes



Time

Person in

ChargeFees Forms


Clerk

b. Gets and fills out

Verification Slip

(OMB Form 4)

c. Submits filled out

OMB Form 4, presents

valid ID, and takes a seat

a. Greets and interviews client

• Verifies if client is a party to the

case, counsel on record, or

authorized representative;

• Instructs the client to write a

formal letter stating the purpose

of the request, if not a party

b. Gives client OMB Form 4 and

asks for a valid ID

c. Examines filled out OMB Form 4

• Asks client to take a seat

• Forwards OMB Form 4 to verifier


Fees

OMB Form 4

REQUEST FOR

CASE INFORMATION

14


Time

Person in

ChargeFees Forms

d. Waits for the release of

OMB Form 4

d. Checks case data base, writes

the requested case information on

OMB Form 4, and forwards the

original and office copy of the form

to the receiving clerk

15 minutes Verifier OMB Form 4

2 a. Receives OMB Form 4 with

notation

b. Signs on the “RECEIVED”

portion of the office copy of

OMB Form 4

a. Gives original OMB Form 4 to the

client

b. Asks client to sign on the

‘RECEIVED’ portion of the office

copy of OMB Form 4 and reminds

client to accomplish and drop

Feedback Form (OMB Form 7) in

the designated box and tells client


5 minutes Receiving Clerk OMB Form 4

OMB Form 7


OMB Form 7 in the

designated box OMB Form 7

END OF TRANSACTION

15

REQUEST FOR

CASE INFORMATION


Time

Person in

ChargeFees Forms


Clerk

b. Fills out and submits

SALN Request Form

(OMB Form 5) and

presents valid ID

a. Greets client and gives OMB

Form 5

b. Receives filled out OMB Form 5,

examines to determine its

completeness, routes to SALN

Custodian and tells client to take

a seat


Fees

OMB Form 5

a. Takes a seat a. Verifies availability of the

requested OMB Form 5 from the

SALN database.

• If not available:

1. Indicates non-availability in

OMB Form 5

2. Explains the reasons for non-

availability

3. Returns OMB Form 5 to client

• If available:

1. Retrieves SALN

2. Photocopies SALN

3. Redacts address of

declarant

4. Certifies copy of SALN,

if requested

35 minutes SALN Custodian


• Any interested person


• SALN Request Form (OMB Form 5)

• Presentation of valid ID


• Sixty (60) minutes per person


REQUEST FOR COPY OF

STATEMENT OF ASSETS, LIABILITIES

AND NETWORTH (SALN)

16

17

REQUEST FOR COPY OF

STATEMENT OF ASSETS, LIABILITIES

AND NETWORTH (SALN)


Time

Person in

ChargeFees Forms

b. Prepares and issues Payment

Slip for Copy of Documents

(OMB Form 3A)

c. Routes OMB Forms 3A and 5 to

Director for approval

OMB Form 3A

2 a. Waits for the release of

SALN

b. Receives OMB Form 3A

a. Approves and routes OMB Forms

3A, 5 and copy of SALN to

receiving clerk

b. Gives OMB Form 3A to client and

directs client to the cashier to pay

the required fees

5 minutes Director

3 a. Goes to Cashier to

pay and gives

OMB Form 3A

b. Receives Official

Receipt (OR)

c. Goes to Records

Division to claim copy of

requested SALN

a. Gets OMB Form 3A and receives

payment

b. Issues OR

c. Directs client to the Records

Division to claim copy of SALN

5 minutes Cashier ₱5.00 per

page for

plain copy /

₱10.00 per

page for

certified

copy

OMB Form 3A

4 a. Presents OR

b. Receives copy of requested

SALN

a. Asks client to present OR, and

writes down payment details in the

OMB Form 5

b. Releases requested copy of SALN

to client and reminds client to

accomplish and drop Feedback

Form (OMB Form 7) in the



10 minutes Receiving Clerk

OMB Form 5

OMB Form 7


OMB Form 7 in the

designated box OMB Form 7

END OF TRANSACTION


Time

Person in

ChargeFees Forms

1 a. Approaches Director of the

concerned office

b. Fills out and submits duly

accomplished OMB Form 6

a. Greets client and gives Redress

Form (OMB Form 6)

b. Receives and checks

OMB Form 6

• If the complaint or grievance

involves a frontline officer:

1. Confers with the frontline

personnel complained against

2. Asks the frontline personnel to

submit a written explanation

within 48 hours

3. Resolves complaint or

grievance

4. Refers complaint to the Internal

Affairs Board, if the complaint

or grievance constitutes an

administrative offense

30 minutes Director of Office

Concerned

No

Fees

OMB Form 6


• Any party who has concerns about Ombudsman procedures, systems, facilities,

services, and personnel


• Duly accomplished Redress Form (OMB Form 6)


• Thirty (30) minutes


REDRESS OF CLIENT

COMPLAINTS AND GRIEVANCES

18


Time

Person in

ChargeFees Forms

5. Determines next course of

action to be taken

• If the complaint or grievance

involves Ombudsman

procedures, systems,

facilities, services:

1. Undertakes appropriate action

either by referring the concerns

to appropriate office for policy

consideration or improvement

2. Files OMB Form 6

END OF TRANSACTION

19

REDRESS OF CLIENT

COMPLAINTS AND GRIEVANCES

OMB Form 1-Application for Ombudsman Clearance Page 1 of 2

REQUIREMENTS: 1. Duly accomplished Application for Ombudsman Clearance (OMB Form 1) and any valid ID

2. Photocopy of service record and death certificate for death claims purposes

3. Payment of clearance fee

CDD Expiration of Term Reversion Awards, please specify:

Death Claim GSIS Claims Separation (Date) Bar Exam Guarantorship Scientific Career System

Disability Retirement Rationalization CES Eligibility Leave Application Study Grant

Discharge Resignation (Date) CESO Rank Loan Application SUC Presidency

Dropped from the Roll Retirement (Date) Change of Name (Specify Name):

End of Contract (Date) TPPD Commissionship Nomination UN Mission

End of Term (Date) Completion of Residency Recognition Visa

Expiration of Appointment Training Requirement by JBC, CSC, CESB, Office of the

Court Requirement President, PRC, GOCC, DFA, DOLE, BI, LTO, NBI,

Appointment Grant of Benefits Reappointment Extension of Service PNP & other agencies: (Please specify agency)

Confirmation Lateral Entry Reemployment Foreign Travel

Employment Promotion Transfer Free and Accepted Scholarship

Schooling

Processing Fee P1,000.00

Bidding Requirements Fidelity Bond Permit to Carry Firearms Firearm License

Cash SM, Hypermart, Savemore Landbank"Office of the Ombudsman Clearance Fees"

pick-up at OMB office prepaid private courier* regular mail

personally office address

authorized representative present/home address

1. Name of Applicant:

Suffix i.e, Jr.

2. Current Position:

4. Agency/Office Name:

Agency/Office Address:

5. Present Address:

House No./Blk. No.

6. Previous Address:

House No./Blk. No.

7. Date of Birth: 8. Civil Status: 9. Sex:

10. Date of Marriage: 11. Contact Nos.:

12. Highest Educational Attainment

Republic of the Philippines

Office of the Ombudsman

Agham Road, Diliman, Quezon City

APPLICATION FOR OMBUDSMAN CLEARANCE

Clearance Fee P150.00

Foreign Assignment

PURPOSE OF CLEARANCE : Please indicate the number of copies in the appropriate box.

Clearance Fee P100.00 Clearance Fee P200.00

Clearance Fee P500.00 Clearance Fee P1,000.00

MODE OF PAYMENT: Please one. Postal money order payable to

MODE OF RELEASE : Please one.

*applicant shall provide prepaid envelope

except if paid thru SM

APPLICANT'S INFORMATION: (Please PRINT legibly. Write "N/A" if not applicable)

First Name Middle Name Last Name

3. If married, mother's maiden surname

(for female applicant)

Street Barangay

City/Municipality Province

Street Barangay

City/Municipality Province

mm/dd/yyyy

mm/dd/yyyy Mobile Landline

Educational

AttainmentPeriod Attended

Educational

AttainmentPeriod Attended

ID Number Issuing Agency/Company

High School Vocational

College Post Graduate

TO BE ACCOMPLISHED BY THE RECEIVING CLERKValid Identification Card presented by the APPLICANT Valid Identification Card presented by the REPRESENTATIVE

Type ID Number Issuing Agency/Company Type

THIS FORM IS NOT FOR SALE. REPRODUCTION IS ALLOWED. THIS CAN ALSO BE DOWNLOADED THRU THE OMBUDSMAN WEBSITE AT www.ombudsman.gov.ph

Masonry


Page 1

FORMS

20

of 2

GOVERNMENT HISTORY

NAME OF OFFICE

PRIVATE SECTOR

NAME OF OFFICE

Printed Name of Applicant/

Authorized Representative :

Signature of Applicant/

Authorized Representative :

Name of Requester in

Case of Death Claim :

N.B. For retirement purposes, an application shall be processed not earlier than six (6) months before the date of retirement.

Tel. Nos.: Central Office - (02) 479-7309 and (02) 926-8786; OMB Visayas - (032) 412-5339; OMB Mindanao - (082) 221-3431

Date

Accomplished:

Relation to the

Deceased:

d.

e.

f.

g.

h.

I declare that the answers given above are true and correct to the best of my knowledge and belief.

a.

b.

c.

h.

ADDRESS POSITIONINCLUSIVE

DATES

b.

c.

d.

e.

f.

g.

13. E M P L O Y M E N T H I S T O R Y (To be accomplished only if service record is not attached. Use additional sheet if necessary.)

ADDRESS POSITIONINCLUSIVE

DATES

a.


Page 2

FORMS

21

OMB Form 1A-Clearance Payment Slip

Please issue Official Receipt in favor of (name) ______________________________________________________________________________________________________

___________________________________________________________________ (amount in numbers) _______________________________________________________

Clearance Fee: PhP

CDD Expiration of Term Reversion Awards, please specify:

Death Claim GSIS Claims Separation (Date:) Bar Exam Guarantorship Scientific Career System

Disability Retirement Rationalization CES Eligibility Leave Application Study Grant

Discharge Resignation (Date) CESO Rank Loan Application SUC Presidency

Dropped from the Roll Retirement (Date) Change of Name (Pls. Specify):

End of Contract (Date) TPPD Commissionship Nomination UN Mission

End of Term (Date) Completion of Residency Recognition Visa

Expiration of Appointment Training Requirement by JBC, CSC, CESB, Office of the

Court Requirement President, PRC, GOCC, DFA, DOLE, BI, LTO, NBI,

Appointment Grant of Benefits Extension of Service

Confirmation Foreign Travel

Employment Free and Accepted Scholarship

PNP & other agencies: (Please specify agency)Schooling

Bidding Requirements Fidelity Bond Permit to Carry Firearms Firearm License

Bill No. :Dated :

Transfer

MasonryForeign Assignment

Clearance Fee P1,000.00

PNP & other agencies: (Please specify agency)

Promotion

Reappointment

Reemployment

Amount


Please deposit the collections under bank account/s

Name and Signature of Receiving Clerk


Lateral Entry

Account Number Name of Bank/Branch

FOR THE PURPOSE/S OF: Please indicate the number of copies in the appropriate box.

Clearance Fee P100.00 Clearance Fee P200.00

Cash Unit

(address) ___________________________________________________________________________________________________________________________________________




CLEARANCE PAYMENT SLIP

The Collecting Officer

Legal Research Fee: PhP

in the amount of (amount in words) ____________________________________________________________________________________________________________________

Date: _________________

3672-1001-42 Landbank / Ombudsman Ext. Office

TOTAL

CLEARANCE PAYMENT SLIP

22

FORMS

Number of copy/ies :

TOTAL

Prepared by:

OMB Form 1B-Payment Slip for Certified Photocopy of Clearance

PAYMENT SLIP FOR CERTIFIED PHOTOCOPY OF

OMBUDSMAN CLEARANCE

Requesting Party




Tel. Nos. (02) 479-7309 loc.2111/2132 & (02) 926-8786

Website: www.ombudsman.gov.ph

Email: [email protected]

₱

Name and Signature Date

₱

₱

PhP 10 per certified copy

PhP 5 if plain copy

PAYMENT FOR CERTIFIED PHOTOCOPY OF

OMBUDSMAN CLEARANCE

FORMS

23

OMB Form 1C-Clearance Claim Slip

Control No.

Date Received:

Due Date:

Received by:

Death Certificate

Authorization Letter (if fi led by representative)

Photocopy of applicant's ID and authorized representative

Note: OMB Clearance not claimed within sixty (60) days from

date of release will be disposed of and no refund of

application fee shall be granted.




When claiming, please bring the following checked items:

NAME OF APPLICANT

Tel. Nos. (02) 479-7309 loc.2111/2132 & (02) 926-8786

CLEARANCE CLAIM SLIP

Website: www.ombudsman.gov.ph

Email: [email protected]

CLEARANCE CLAIM SLIP

24

FORMS

OMB Form 2-Request for Assistance

: (02) 926-2662

: (02) 479-7300 loc. 2101/2104

: [email protected]

: www.ombudsman.gov.ph

Walk-in Phone-in

TO BE ACCOMPLISHED BY THE REQUESTER

1. Name of Requester/Caller : 2. Sex

3. Age :

4. Residence/Business Address :

5. Contact Information : Mobile : Landline : e-Mail Address :

6. Nature of Request/s :

Referral Medical/Financial Money claims Others, please specify

7. Agency/Person/s complained of :

Please check (/) appropriate box:

Yes, this is my first time in seeking the assistance of the Office of the Ombudsman regarding this matter.

No, I previously sought the assistance of the Office of the Ombudsman regarding this matter on

The name of the Action Officer was

Signature of Requester : Date :

TO BE ACCOMPLISHED BY THE PAB ACTION OFFICER

ACTION(S) TAKEN:

Name/Signature : Date :

FINAL DISPOSITION:

Name/Signature : Date :

APPROVED/DISAPPROVED

Director, Public Assistance Bureau

Name of Assisting OMB Employee

NATURE/DETAILS (use back page, if necessary)


a.

61 and above

Position

Province

PAB/OMB-Luz/OMB-Vis/OMB-Min/MOLEO

Follow-up status

Name

Agham Road, Diliman, Quezon CityWebsite

Email

Please Check ( / )

appropriate box

20 and below 21-40

of OMB Case documents/transactions

41-60

c.

b.

Agency/Address

House No./Blk. No.

RAS - ___ - _____ - __________


e-Mail Address/

Contact No.

OFA- ___ - _____ - __________

Barangay

City/Municipality

Oath

Street



CONTACT US:

Follow-up letters/ Query/Legal advice

PAB Hotline

Trunkline

REQUEST FOR ASSISTANCE FORM

FORMS

25

REQUEST FOR COPY OF CASE DOCUMENTS

26

FORMS

PAYMENT FOR COPY OF CASE DOCUMENTS

FORMS

27

OMB Form 3A-Payment for Copy of Case Documents

Complaint-Affidavit

Exhibits/Annexes

Counter-Affidavit

Reply

Position Paper

Resolution

Decision

Order

Motion for Reconsideration

SALN

Others, please specify

Grand Total

OR. No.:

Date :

Amount Paid :

₱

₱

₱

₱

₱

₱

₱

₱

PAYMENT SLIP Republic of the Philippines

Office of the OmbudsmanDate : Agham Road, Diliman, Quezon City

PAYMENT FOR COPY OF DOCUMENTS

Documents RequestedNo. of

Pages

Price per

PageAmount

OMB Reference No./Case No.:Requesting Party :

Number

of Copies

Certified

True

Copy

APPROVED/DISAPPROVED

Chief, Central Records Division ₱

Plain

copy

₱

₱

₱

₱

Name of Requester:

First Name Last Name Suffix e.g. Jr, III

Signature:

Type of Requester (Please check the appropriate box)

Complainant Counsel for:

Respondent

Authorized Representative

Others, please specify

House No./Blk. No.

Contact Number:

Case Number/Reference:

Type ID Number Type

Status of the Case Under evaluation With Pending MR

Under preliminary investigation or For Prosecution

administrative adjudication Convicted

Under fact-finding investigation Acquitted

Under review

Resolved on:

Referred to: OMB-Luzon OMB-Mindanao Other Agency

OMB-Visayas OMB-MOLEO

Referred on:

Referred to Public Assistance Bureau on

For Mediation on

Remarks:

Signature over Printed Name of Records Officer or

Personnel-in-Charge

Signature over Printed Name of Requester or

Issuing Agency/Company

Valid Identification Card presented by the REQUESTER Valid Identification Card presented by the REPRESENTATIVE

Name of Party

Issuing Agency/Company

City/Municipality

Address:

ID Number

Street


Note: The case status is limited to the above-cited information pursuant to OMB Office Order No. 88, s.1992 - Rule on Confidentiality.

Date

Barangay

Mobile

Province

Date

Authorized Representative

TO BE ACCOMPLISHED BY OMB PERSONNEL

Landline

R E C E I V E D B Y :

OMB Form 4-Request for Case Information (Verification Slip)




(VERIFICATION SLIP)

Middle Name

TO BE ACCOMPLISHED BY THE REQUESTER

REQUEST FOR CASE INFORMATION

Date:

V E R I F I E D B Y :

Sex:

(Requirements: copy of Entry of Appearance with Conformity of Party/ies or copy of Entry/date filed)

REQUEST FOR CASE INFORMATION FORM

28

FORMS

SALN REQUEST FORM

FORMS

29

OMB Form 6-Redress Form

: (02) 926-2662

: (02) 479-7300 loc. 2101/2104

: [email protected]

: www.ombudsman.gov.ph

Please put a

check ( / )

Services

(Serbisyo)

Name and Signature

(Pangalan at Pirma)

3. Sex

(Kasarian)

5. Residence Address

(Tirahan)

Facilities

(Pasilidad)

7. Concern/s regarding….

(Hinaing patungkol sa)

Trunkline

PAB Hotline


6. Contact Number

(Numerong Tatawagan)

8. What are the details of your concern/s?

(Ano po ang mga detalye ng inyong hinaing?)

1. Date

(Petsa)

OMB Procedures

(Pamamaraan)

Systems

(Sistema)


C O N T A C T U S:

Agham Road, Diliman, Quezon CityWebsite

Email


REDRESS FORM

4. Office/Address

(Tanggapan/Lugar)

(Regarding OMB Procedures, Systems, Facilities, Services, and Personnel)

Personnel

(Kawani)

2. Name

(Pangalan)

REDRESS FORM

30

FORMS

FEEDBACK FORM

FORMS

31

WHERE TO FILE

DIRECTORY

Office of the OmbudsmanAgham Road, North Triangle

Diliman, Quezon City

Public Assistance Bureau (PAB) : Tel. No. (02) 479-7300 local 2101 & 2104

(02) 926-2662 & (02) 920-3783

PAB Clearance Section : Tel. No. (02) 479-7309 local 2111 & 2132

(02) 926-8786

Central Records Division : Tel. No. (02) 479-7300 local 2222, 2223 & 2226

(02) 926-8752

Office of the Deputy Ombudsman for Luzon3/F Office of the Ombudsman

Agham Road, North Triangle, Diliman, Quezon City

Tel. No. (02) 479-7300 local 4325, 4327 & 4330

(02) 926-8741

Office of the Deputy Ombudsman for VisayasDepartment of Agriculture, Regional Office-7 Compound

M. Velez St., Guadalupe, 6000 Cebu City

Tel. No. (032) 255-0977

Telefax (032) 253-0981

Office of the Deputy Ombudsman for Visayas

Iloilo Regional OfficeG/F CAP Building, Gen. Luna St. Iloilo City

Tel. No. (033) 509-4655

(033) 509-5644

Office of the Deputy Ombudsman for Visayas

Tacloban Regional Office3/F Yuhoo Building, Marasbaras, Tacloban City

Tel. No. (053) 523-4010

(053) 523-3042

Office of the Deputy Ombudsman for MindanaoAlvarez St. cor. Ramon Magsaysay Ave.

Davao City

Tel. No. (082) 221-3431 to 33

Telefax (082) 221-3938

Office of the Deputy Ombudsman for Mindanao

Cagayan De Oro Regional OfficeG/F ALU-TUCP. Kauswagan National Highway

Cagayan De Oro City

Tel. No. (088) 8809 008

Telefax (088) 8809 009

Office of the Deputy Ombudsman for the

Military and Other Law Enforcement Offices2/F Office of the Ombudsman

Agham Road, North Triangle

Diliman, Quezon City

Tel. No. (02) 479-7300 local 5209 & 5314

(02) 926-8770

OMB – Office of the Special Prosecutor (OSP)4th-5th Floor, Ombudsman Building

Agham Road, North Triangle, Diliman, Quezon City

Tel. No. (02) 926-7025; 479-7300 local 3501-3502

32

Via on-line : www.ombudsman.gov.ph

OFFICE OF THE OMBUDSMANAgham Road, Diliman

Quezon City, Philippines 1101

www.ombudsman.gov.ph

September 2017