Republic of the Philippines

COMMISSION ON AUDIT
Commonwealth Avenue, Quezon City
Office of the Commissioner

<Name of Petitioner/s, all of < Name of Agency>

Petitioner,
Case No. _____________________
-versus N.D. No: _____________________

<>
Respondent.

x------------------------------------------------------------x

PETITION FOR REVIEW

Petitioner______________, with office address

at___________________________________, by Counsel, unto this Honorable Office most

respectfully states:

THE PARTIES

Petitioner ________ is a ______________________________, with principal address at

__________

Respondent _________________ is the ______________

NATURE OF THE PETITION

This is an appeal pursuant to Rule VII of the 2009 Revised Rules of Procedure of the

Commission on Audit against the Decision dated _____ of Respondent ________, details of

which are shown in the attached notices of disallowance/s.

TIMELINESS OF THE PETITION

As provided under Section 4, Rule V, the period to appeal must be done within six

months, taking into account the suspension of the running thereof under Section 5 of the same

Rule, in case appeals from the Directors decision. The above-mentioned Notice of
Disallowance/s were received by the ____________ (Petitioner) on ________________ . The

Appeal memorandum was filed on _________________. Petitioner therefore has __________

left from receipt of the assailed Decision to file the Petition for Review.

The assailed Decision dated ________________ was received by petitioner on

_______________, hence it has until ____________, within which to file the appeal by way of

Petition for Review. Thus, the Petition for Review is filed well within the prescribed period

allowed.

BRIEF STATEMENT OF FACTS AND THE CASE

ISSUES

ARGUMENTS/ DISCUSSION

PRAYER

WHEREFORE, premises considered, it is most respectfully prayed of this Honorable

Commission that the assailed Decision dated _______ of Respondent _________________, be

ordered set aside and annulled. Other reliefs just and equitable under the premises are likewise

prayed for.

___________________ at __________________.
 EXPLANATION

Copy of the foregoing is filed with the Honorable Commissioner and served to adverse

party, by registered mail as the required personal service cannot be made due to geographical

distance.

Copy furnished:

Respondent
REPUBLIC OF THE PHILIPPINES )
) S. S.

AFFIDAVIT OF SERVICE

I/ We, the Petitioner/s, (all) of legal age, Filipino and residents of _______________,

Philippines, after having been duly sworn to an oath in accordance with law, hereby depose and

say, that:

1. That I am _________________ of the ___________________________;

2. That on ____________, I served copy of the Petition for Review to the party by

registered mail, as evidenced by the registry receipts indicated herein below:

3. That I am executing this Affidavit in order to attest to the truth of the foregoing

allegations;

IN WITNESS WHEREOF, I/we have hereunto affixed my/our signature/s this ___ of

__________ at _________, Philippines.

Affiant

SUBSCRIBE AND SWORN TO before me this ________________________ at

________________, Philippines. Affiant having exhibited his/her _____________________

issued on _________ at _________, Philippines.

Notary Public

Doc. No.
Page No.
Book No.
Series of _____