CS Form No.

4
Series of 2017

Republic of the Philippines

PHILIPPINE NATIONAL POLICE

CERTIFICATION OF ASSUMPTION TO DUTY

This is to certify that Ms/Mr. _________________________ has assumed

the duties and responsibilities as ___________________________________ of
______________________________________ effective _________________.

This certification is issued in connection with the issuance of the

appointment of Ms/Mr ___________________________________________ as
________________________.

Done this ____ day of __________ ________ in ______________.

__________________________
Head of Office/Department/Unit

Date: ________________

Attested by:

PSSUPT JOSE SANTIAGO HIDALGO JR

Highest Ranking HRMO

201 file
Admin
COA
CSC For submission to CSCFO
within 30 days from the
date of assumption of the
appointee