Republic of the Philippines
____________ Judicial Region
REGIONAL TRIAL COURT OF __________
____________________ CITY
Branch ___
_____________________ City
PEOPLE OF THE PHILIPPINES,
Plaintiff, Crim. Case No. _________
- versus - for
JUAN DELA CRUZ, ____________________
Accused.
X------------------------------------------------X
APPLICATION FOR PROBATION
The undersigned accused, JUAN DELA CRUZ, files this application for probation
under the provisions of PD 968 as amended, hereby declares:
1. That Petitioner is _______ years of age, single/married/widow/widower and a
resident of ________________________________________________________;
2. That Petitioner has been convicted of __________________________________
and sentenced to serve a term of imprisonment of not more than six (6) years or to
pay a fine of not more than One Thousand Pesos (Ᵽ1,000.00) with subsidiary
imprisonment in case of insolvency;
3. That Petitioner has not begun to serve the term of imprisonment imposed nor paid
the fine imposed;
4. That the crime of which Petitioner has been convicted is not an offense against
the national security;
5. That Petitioner has not previously been convicted by final judgment of any offense
punished by imprisonment of not more than six (6) months and one (1) day or a fine
of not more than one thousand pesos (Ᵽ1000.00); and
6. That Petitioner has not been once on probation under the provisions of PD 968 as
amended.
_____________ City, ______________.
JUAN DELA CRUZ
Print Name and Signature of Applicant