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Subject: Defense Request                                                                                            Date:

…………………………………………

It is alleged that I have a behavior at the date ………………… in the manner of ………………………….

My written defence on the subject is as follows.

…………………………………………..

I am kindly submitting for your information.

                                                                                   Employee Name Surname/Date/Signature

Record Annotation/Date/Signature