CBF 17

Application for Probation

Original Court, 1st Copy Prosecutor, 2nd Copy Accused, Other copies as needed
Enter information in block letters in all parts of the Form except when reserved for Court use, which shall be
completed by the Clerk.

For Court Use Only

(Judicial Region)

METC/MTCC/MTC/MCTC Case No.
RTC

(Municipality/City/Province)

BRANCH

People of the Philippines , v.

,
Accused.

ATTORNEY OR PARTY WITHOUT ATTORNEY

Name
Firm Name
Address
Email Address
Tel./Cel./Fax Nos.
PTR No. Date/Place of Issuance
Roll No. Date/Place of Issuance
IBP No. Lifetime Date/Chapter
MCLE Compliance Exemption No.

Other Compliances

Attorney for
Prosecution: Public Prosecutor Private Prosecutor
Defense: Public Attorney Private Counsel
Other

APPLICATION FOR PROBATION

Accused applies for the approval of his application for Probation

under the provisions of Presidential Decree No. 968, as amended, and states that:

1. On , accused was convicted of the crime of and was sentenced

to
suffer imprisonment; or
pay a fine of Pwith subsidiary imprisonment in case of
insolvency.

2. The crime for which the accused was convicted is not an offense against
national security or public order.

3. Accused has not been previously convicted by final judgment of any offense
punishable by imprisonment of not less than one (1) month and one (1) day
and/or fine of not less than two hundred pesos.

4. Accused has not previously been placed on probation under the provisions of
PD 968, as amended.

5. Accused has all the qualifications and none of the disqualifications to avail
of the benefits of PD 968.

APPLICATION FOR PROBATION Page 1 of 3

 CBF 17
Application for Probation

Accused Date

Defense Counsel

COPY FURNISHED

Persons Name Method Place Served Date

Served
Personal Service
Trial Prosecutor Courier Service
Facsimile, Email,
SMS
Personal Service
Counsel for Accused Courier Service
Facsimile, Email,
SMS
Personal Service
Private Complainant Courier Service
Facsimile, Email,
SMS
Personal Service
Accused Courier Service
Facsimile, Email,
SMS
Personal Service
Courier Service
Facsimile, Email,
SMS
Personal Service
Courier Service
Facsimile, Email,
SMS
Proof of such service is attached to this Application as Annex.

Date Party/Partys Counsels name and signature

ORDER

The application for probation is referred to the Parole and Probation Officer
of City for the requisite post-sentence investigation and report within sixty
(60) days from receipt of this Order.

The trial prosecutor is given ten (10) days from receipt hereof to comment
on the application.

SO ORDERED.

Judge Date

APPLICATION FOR PROBATION Page 2 of 3

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Application for Probation

SPECIAL INSTRUCTIONS

Copies to be filed with the Court

An original of this Form must be filed with the Court together with such additional copies
equivalent to the number of parties in the case, to be used by the Court in sending out its court
order contained in the same Form.

Grant of Probation
Subject to the provisions of this Decree, the court may, after it shall have convicted and
sentenced a defendant and upon application at any time of said defendant, suspend the execution
of said sentence and place the defendant on probation for such period and upon such terms and
conditions as it may deem best.

Probation may be granted whether the sentence imposes a term of imprisonment or a fine only.
An application for probation shall be filed with the trial court, with notice to the appellate court if
an appeal has been taken from the sentence of conviction. The filing of the application shall be
deemed a waiver of the right to appeal, or the automatic withdrawal of a pending appeal.

An order granting or denying probation shall not be appealable. (Section 4, PD 968)

Disqualified Offenders
The benefits of this Decree shall not be extended to those:
(a) sentenced to serve a maximum term of imprisonment of more than six years;
(b) convicted of any offense against the security of the State;
(c) who have previously been convicted by final judgment of an offense punished by
imprisonment of not less than one month and one day and/or a fine of not less than Two
Hundred Pesos;
(d) who have been once on probation under the provisions of this Decree; and
(e) who are already serving sentence at the time the substantive provisions of this Decree
became applicable pursuant to Section 33 hereof. (Section 9, PD 968)

APPLICATION FOR PROBATION Page 3 of 3