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Republic of the Philippines · City of Pagadian SANGGUNIANG PANLUNGSODOffice of the Secretary of the Sanggunian

File a concern, petition or request letter

CONTROL NO. (office use) 

Form SP-F05 · Simple transaction · Processing: For verification · Fee: For verification

A. Requesting party

DateTime
Name
Address / Barangay
Contact no.E-mail
Office / organization (if any)

B. Request details

Subject
Barangay / place concerned
Details of the concern
What action do you ask for?

C. Documents attached / to be presented

I certify that the information above is true. I consent to the collection and use of my personal data by the Sangguniang Panlungsod only for processing this request, under the Data Privacy Act of 2012 (RA 10173).

Signature over printed name
Date
FOR OFFICE USE ONLY
Received by
Date / time
Documents complete?☐ Yes☐ No — lacking:
Referred to
O.R. no. / amount
Action taken
Released by
Date released
SP-F05 · Rev. 2026-10 Track online: sppagarchive.com/visitor/track.php