Appendix 43

CASH DISBURSEMENT REGISTER

For the Months of November, 2020 (SIGA)
Entity Name: Department of Education Name of Accountable Officer: Riza A Penaso
Sub-Office/District/Division: Dapitan City Division Official Designation: SSP-I
Municipality/City/Province: Dapitan City/Zamboanga del Norte Station: Aseniero NHS
Fund Cluster: 101 Register No : 17 Register No : 17 - 006
Sheet No. 1
Advance for Operatiing Expenses
(19901010)
BREAKDOWN OF PAYMENTS

DV/Payroll/C Amount Other Supplies OTHERS

Date heck No.
Particulars
Due to BIR & Materials
Travelling Expenses Invy. UACS
Cash Advance Payments Balance Account Description Amount
Object Code
20201010-00 50502010-00 10404990-00
MOOE-Nov., 2020(SIGA) 50,000.00
Mercury Drug 167.75 49,832.25 167.75
J & P Fruit Nursery 1,820.00 48,012.25 1,820.00
Prince Hypermart 908.50 47,103.75 908.50
Jerolen Ent Corp 6,950.00 40,153.75 6,950.00
Jerolen Ent Corp 8,488.00 31,665.75 8,488.00
Boholana Handicraft 2,200.00 29,465.75 2,200.00
JS Bread Time 750.00 28,715.75 750.00
Sebio Educ. Supply 1,491.75 27,224.00 1,491.75
Isaias Top Marketing 27,055.00 169.00 27,055.00
Riza A Penaso 200.00 -31.00 Transpo & delivery 50203050-00 200.00
Total 50,031.00 ­ ­ 49,831.00 200.00
Recapitulation:
UACS Object
Account Description Amount
Code
Transpo & delivery 50203050-00 200.00
Other Supplies & Mat's 10404990-00 49.831.00
Total 50,031.00
The total of the ' dvances for Oprating Expenses - Payments' column must always be equal to thesum of the totals of the
'Breakdown of Payments' columns.

CERTIFIED CORRECT: RECEIVED BY:

RIZA A. PENASO NERISSA T. LUANG

Signature over Printed Name Signature over Printed Name
Date: Date:
 .

…………………….
 Appendix 32

ASENIERO NATIONAL HIGH SCHOOL Fund Cluster:

Entity Name
Date:
DV No: _________
DISBURSEMENT VOUCHER

Mode of
MDS Check Commercial Check ADA Others (Please specify)
Payment

Payee Prince Hypermart

TIN/Employee No.: ORS/BURS No.:

Address Dapitan City, Zamboanga del Norte

Responsibility
Particulars MFO/PAP Amount
Center
To payment of Gulayan Supplies, per supporting P908.50
papers
hereto attached…

Amount Due P908.50

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

RIZA A. PENASO
Printed Name, Designation and Signature of Supervisor

B. Accounting Entry:
Account t Title Debit Credit

C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Supporting documents complete and amount claimed
proper

Signature Signature
Printed
Printed
Name JACKYLYN L. ACADEMIA RIZA A PENASO
Name
SST - I/Des. Bookkeeper SSP-I
Position Position
Head, Accounting Unit/Authorize Representative Agency Head/Authorized Representative

Date Date
E. Receipt of Payment JEV No.
Check Date: Bank Name & Account Number:
No.
Date: Date:
Signature
Printed Name
Official Receipt No. & Date/Other Documents
92
 Appendix 61

PURCHASE ORDER
Aseniero National High School
Entity Name
Supplier: J & P Fruit Nursery P.O. No. : ______________________________
Address: Lingasad, Polanco, Zamboanga del Norte Date:
TIN: Mode of Procurement: Shopping
Gentlemen:
Please furnish this Office of the following articles subject to the terms and conditions contained herein:
Place of Delivery: _____________________________________ Delivery Term: __________________________
Date of Delivery: _____________________________________ Payment Term: __________________________
Stock/
Unit Description Quantity Unit Cost Amount
Property No.
1 piece Seedling (Lanzones) 5 70.00 ₱350.00
2 piece Seedling (Durian) 5 70.00 ₱350.00
3 piece Seedling (Mangosteen) 5 70.00 ₱350.00
4 piece Seedling (Rambutan) 5 70.00 ₱350.00
5 piece Seedling (Calamansi) 6 70.00 ₱420.00

₱1,820.00
(Total Amount in Words) One Thousand Eight Hundred Twenty Pesos Only.
In case of failure to make the full delivery within the time specified above, a penalty of one-tenth (1/10) of one percent for
every day of delay shall be imposed on the undelivered item/s.

Conforme: Very truly yours,

________________________________________________ RIZA A. PENASO

Signature over Printed Name of Supplier Signature over Printed Name of Authorized Official

__________________________ SSP - I
Date Designation

Fund Cluster: ______________________________ ORS/BURS No.: _______________________

Fund Available: ______________________________ Date of the ORS/BURS: __________________

JACKLYN L. ACADEMIA Amount: ____________________________

Signature over Printed Name of Chief Accountant/Head of
Accounting Division/Unit
153
 Appendix 61

PURCHASE ORDER
Aseniero National High School
Entity Name
Supplier: Prince Hypermart P.O. No. : ______________________________
Dapitan City, Zamboanga del Norte Date:
TIN: Mode of Procurement: Shopping
Gentlemen:
Please furnish this Office of the following articles subject to the terms and conditions contained herein:
Place of Delivery: _____________________________________ Delivery Term: __________________________
Date of Delivery: _____________________________________ Payment Term: __________________________
Stock/
Unit Description Quantity Unit Cost Amount
Property No.
1 piece Plastic Basin (Small) 3 32.95 98.85
2 piece Plastic Basin (Large) 3 129.95 389.85
3 piece Plastic Pail (Small) 2 79.95 159.9
4 piece Plastic Pail (Large) 2 129.95 259.9

₱908.50
(Total Amount in Words) Nine Hundred Eight Pesos and Fifty Centavos Only.
In case of failure to make the full delivery within the time specified above, a penalty of one-tenth (1/10) of one percent for
every day of delay shall be imposed on the undelivered item/s.

Conforme: Very truly yours,

________________________________________________ RIZA A. PENASO

Signature over Printed Name of Supplier Signature over Printed Name of Authorized Official

__________________________ SSP - I
Date Designation

Fund Cluster: ______________________________ ORS/BURS No.: _______________________

Fund Available: ______________________________ Date of the ORS/BURS: __________________

JACKLYN L. ACADEMIA Amount: ____________________________

Signature over Printed Name of Chief Accountant/Head of
Accounting Division/Unit

153
 Appendix 32

ASENIERO NATIONAL HIGH SCHOOL Fund Cluster:

Entity Name
Date:
DV No: _________
DISBURSEMENT VOUCHER

Mode of
MDS Check Commercial Check ADA Others (Please specify)
Payment

Payee Prince Hypermart

TIN/Employee No.: ORS/BURS No.:

Address Dapitan City, Zamboanga del Norte

Responsibility
Particulars MFO/PAP Amount
Center
To payment of Gulayan Supplies, per supporting P908.50
papers
hereto attached…

Amount Due P908.50

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

RIZA A. PENASO
Printed Name, Designation and Signature of Supervisor

B. Accounting Entry:
Account t Title Debit Credit

C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Supporting documents complete and amount claimed
proper

Signature Signature
Printed
Printed
Name JACKYLYN L. ACADEMIA RIZA A PENASO
Name
SST - I/Des. Bookkeeper SSP-I
Position Position
Head, Accounting Unit/Authorize Representative Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Check Date: Bank Name & Account Number:
No.
Date: Date:
Signature
Printed Name
Official Receipt No. & Date/Other Documents
92