Appendix 32

LIBERACION ELEMENTARY SCHOOL Fund Cluster :

Entity Name
Date :
DISBURSEMENT VOUCHER

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

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee FELIPA A. SANDOVAL

Address Brgy. Cuatro de Agosto, Mahaplag, Leyte

Responsibility
Particulars MFO/PAP Amount
Center

To payment of ________________ as per supporting

papers hereto attched in the amount of ______________

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

ARACELI M. GONZAGA
Head Teacher - I

B. Accounting Entry:
Account Title UACS Code Debit Credit

Cash, Modified Disbursing System, Regular 5020305000

C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Sup
proper

Signature Signature

Printed
Name
ROWENA D. PANGUE Printed Name ARACELI M. GONZAGA

Position Senior Book Keeper Position Head Teacher - I

Date Date

E. Receipt of Payment JEV No.

Check/ Date : Bank Name & Account Number:
ADA No. :
Date : Printed Name: Date
Signature :
Official Receipt No. & Date/Other Documents

92
 Appendix 33

PAYROLL
For the period JANUARY 2017

Entity Name : (Name of School) Payroll No. : _______________________

Fund Cluster : 01 Sheet _________of __________Sheets
We acknowledge receipt of cash shown opposite our name as full compensation for services rendered for the period covered.

COMPENSATIONS DEDUCTIONS
Serial Employee Net Amount
Name Position Gross Amount Total Signature of Recipient
No. No. Salary Due
Earned Deductions
94

A CERTIFIED: Services duly rendered as stated. C APPROVED FOR PAYMENT: _________________________________________________________________

_____________________________________________________________________(P )

(Name of School Head)

Signature over Printed Name of Authorized Official Date (Signature over Printed Name) Date
Head of Agency/Authorized
Representative

B CERTIFIED: Supporting documents complete and proper; and cash available in the D CERTIFIED: Each employee whose name appears on the payroll E
amount of P______________________. has been paid the amount as indicated opposite his/her name
ORS/BURS No. : _______________
Date : ____________________
(Name of Disbursing Officer Designate) JEV No. : _____________________
(Signature over Printed Name) Date (Signature over Printed Name) Date : ____________________
Head of Accounting Division/Unit Disbursing Officer
 Appendix 43

CASH DISBURSEMENT REGISTER

Entity Name: LIBERACION ELEMENTARY SCHOOL Name of Accountable Officer: IVY JOY C. DE ASIS
Sub-Office/District/Division: MAHAPLAG 1 Official Designation: Teacher-In-Charge
Municipality/City/Province: MAHAPLAG,LEYTE Station: LIBERACION ELEMENTARY SCHOOL
Fund Cluster : MOOE ELEMENTARY Register No. : __________________________________
Sheet No. : ____________________________________

Cash -MDS, Regular BREAKDOWN OF PAYMENTS

1010404000
DV/Payroll/
Date Check/ADA Particulars Amount Traveling Office OTHERS
No. Training
Expenses - Supplies
Expenses
Cash Local Expenses UACS Object
Payments Balance Account Description Amount
Advance Code
5020101000 5020201000 5020301000
MOOE JANUARY, 2022 15,596.00 15,596.00
01-20-2022 2022-01-0001 REMALYN R. TUMOLAC 15,596.00 2,000.00 13,596.00 Janitorial Services 5021202000 2,000.00
01-20-2022 2022-01-0002 JETHRO SOLIS 1,600.00 11,996.00 Janitorial Services 5021202000 1,600.00
01-22-2022 2022-01-0003 BERNALDO CALIPAYAN 600.00 11,396.00 Other General Services 5021299099 600.00
02-08-2022 2022-01-0004 GRC BUILDERS & ENTERPRISES 990.00 10,406.00 Other Supplies and Materials Expenses 5020399000 990.00
02-09-2022 2022-01-0005 LAND BANK 1,500.00 8,906.00 400.00 Other General Services 5021299099 1,500.00
02-09-2022 2022-01-0006 IVY JOY C. DE ASIS 400.00 8,506.00 Traveling Expenses 5020101000
02-11-2022 2022-01-0007 LBC EXPRESS INC. 215.00 8,291.00 Postage and Courier Services 5020501000 215.00
02-14-2022 2022-01-0008 ALIENTECH DIGITAL 300.00 7,991.00 Repairs and Maintenance - Office Equipment 5021305002 300.00
02-15-2022 2022-01-0009 LBC EXPRESS INC. 180.00 7,811.00 Postage and Courier Services 5020501000 180.00
02-16-2022 2022-01-0010 DORELCO 984.25 6,826.75 Electricity Expenses 5020402000 984.25
02-16-2022 2022-01-0011 DORELCO 609.62 6,217.13 Electricity Expenses 5020402000 609.62
02-19-2022 2022-01-0012 CELLWORK DIGITAL ENTERTAINMENT 1,000.00 5,217.13 Telephone Expenses -Moble 5020502001 1,000.00
02-19-2022 2022-01-0013 CELLWORK DIGITAL ENTERTAINMEN 500.00 4,717.13 Internet Subscription Expenses 5020503000 500.00
02-19-2022 2022-01-0014 G AND S STORE 1,000.00 3,717.13 1,000.00 Office Supplies Expenses 5020301002
02-21-2022 2022-01-0015 ITECH INTERNET CAFÉ 300.00 3,417.13 Other General Services 5021299099 300.00
02-22-2022 2022-01-0016 IVY JOY C. DE ASIS 1,300.00 2,117.13 1,300.00 Traveling Expenses 5020101000
02-22-2022 2022-01-0017 G AND S STORE 2,118.00 (0.87) 918.00 Other Supplies and Materials Expenses 5020399000 2,118.00
02-23-2022 2022-01-0018 G AND S STORE Other Supplies and Materials Expenses 5020399000 1,200
- Fidelity Bond Premiums 5021502000
- Other Supplies and Materials Expenses 5020399000 2,118
- Janitorial Services 5021202000
Totals 15,596.00 15,596.87 1,700.00 - 1,918.00 16,214.87
 Recapitulation:

Account Description UACS Object Code Amount

Traveling Expenses 5020101000 1,700.00
Training Expenses 5020201000
Office Supplies Expenses 5020301000 1,918.00
Other Supplies and Materials Expenses 5020399000 2,190.00
Other Supplies and Materials Expenses 5020399000
Electricity Expenses 5020402000 1,593.87
Postage and Courier Services 5020501000 395.00
Telephone Expenses - Mobile 5020502001 1,000.00
Internet Subscription Expenses 5020503000 500.00
Drugs and Medicines Expenses 5020307000
Janitorial Services 5021202000 3,600.00
Security Services 5021203000
Other Professional Services 5021199000
Repairs and Maintenance - School Buildings 5021304002
Repairs and Maintenance - Office Equipment 5021305002 600.00
Fidelity Bond Premiums 5021502000
Printing and Publication Expenses 5029902000
Other General Services 5021299099 2,100.00
Other Maintenance and Operating Expenses 5029999000
Total 15,596.87

The total of the ‘Advances for Operating Expenses – Payments’ column must always be equal to the sum of the totals of the ‘Breakdown of Payments’
columns.
CERTIFIED CORRECT: RECEIVED BY:

IVY JOY C. DE ASIS

Signature over Printed Name Signature over Printed Name

Date: 02- 28-2022 Date: 02-28-2022

 Appendix 44

LIQUIDATION REPORT Serial No.: 2017-01-0001

Period Covered JANUARY 2017 Date: _____________________

Entity Name : (Name of School) Responsibility Center Code:

Fund Cluster : 01 __________________________

PARTICULARS AMOUNT

Liquidation of School MOOE of (Name of School) for the month 15,000.00

of JANUARY 2017.

TOTAL AMOUNT SPENT 15,000.00

AMOUNT OF CASH ADVANCE PER DV NO.______DTD. ______ 15,000.00
AMOUNT REFUNDED PER OR NO. ________DTD. ___________
AMOUNT TO BE REIMBURSED 15,000.00
A Certified: Correctness of the B Certified: Purpose of travel / Certified:
C complete andSupporting
proper documents
above data cash advance duly accomplished

(Name of School Head) (Name of District Supervicor)

Signature over Printed Name Signature over Printed Name Signature over Printed Name
Claimant Immediate Supervisor Head, Accounting Division Unit

JEV No.: ___________________

Date: ______________________ Date: _____________________ Date: _____________________

 Appendix 45

ITINERARY OF TRAVEL

Entity Name : (Name of School)

Fund Cluster: 01 No.: _______________

Name : (Name of Claimant) Date of Travel : _____________________________

Position : __________________________________________ Purpose of Travel : __________________________
Official Station : _____________________________________ ___________________________________________
Places to be visited TIME Means of Transpor Per Total
Date Others
(Destination) Departure Arrival Transportation -station Diem Amount

TOTAL
Prepared by :

I certify that : (1) I have reviewed the foregoing (Name of Claimant)

itinerary, (2) the travel is necessary to the Signature over Printed Name
service, (3) the period covered is reasonable and
(4) the expenses claimed are proper.
Approved by:

(Name of School Head) (Name of District Supervisor)

Signature over Printed Name Signature over Printed Name
Immediate Supervisor Agency Head/Authorized Representative
 Appendix 46

REIMBURSEMENT EXPENSE RECEIPT

Entity Name: TAGAYTAY ES Fund Cluster :

Date : _______________________ RER No. : ___________________

RECEIVED from MERCEDITA C. BALANE

(Name)

PRINCIPAL - I the amount

(Official Designation)

of THREE HUNDRED PESOS ONLY (P 300.00)

(In Words) (in Figures)

________________________________________________________
(Payments for subsistence, services,

_________________________________________________________
rental or transportation should show inclusive dates,

_________________________________________________________
purpose, distance, inclusive points of travel, etc.)
PAYEE
Name/Signature __________________________________________
Address ________________________________________________

WITNESS
Name/Signature __________________________________________
Address ________________________________________________
 Appendix 60

PURCHASE REQUEST

Entity Name: LIBERACION ELEMENTARY SCHOOL Fund Cluster: 01

Office/Section : _____________ PR No.: 2017-01-0001 Date: ____________

_________________________ Responsibility Center Code : ___________

Stock/ Property
Unit Item Description Quantity Unit Cost Total Cost
No.

Purpose: ____________________________________________________________
_______________________________________________________________
_______________________________________________________________

Requested by: Approved by:

Signature : _________________________ ____________________________________
Printed Name : JULIE ANN D. APOLINARIO ARACELI M. GONZAGA
Designation : Property Custodian Head Teacher-1
 Appendix 61

PURCHASE ORDER
PARIL ELEMENTARY SCHOOL
Entity Name

Supplier : _____________________________________________ P.O. No. :

Address : _____________________________________________ Date : _______________________________
TIN : ________________________________________________ Mode of Procurement : (Shopping/through Procureme
Gentlemen:
Please furnish this Office 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.

(Total Amount in Words)

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,

__________________________ JONATHAN C. LUNGARES

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

___________________________ Head Teacher - I

Date Designation

Fund Cluster : ORS/BURS No. : ______________________

Funds Available : _________________________________ Date of the ORS/BURS: _______________

Amount : ____________________________

Signature over Printed Name of Chief Accountant/Head of

Accounting Division/Unit
 Appendix 62

INSPECTION AND ACCEPTANCE REPORT

Entity Name : LIBERACION ELEMENTARY SCHOOL Fund Cluster : 01

Supplier : ______________________________________________ IAR No. : 2017-01-0001

PO No./Date : ___________________________________________ Date : _________________
Requisitioning Office/Dept. : _______________________________ Invoice No. : ____________
Responsibility Center Code : _______________________________ Date : _________________

Stock/
Description Unit Quantity
Property No.

INSPECTION ACCEPTANCE

Date Inspected : ________________________ Date Received : _____________________

Inspected, verified and found in order as to Complete

quantity and specifications
Partial (pls. specify quantity)

MA.CONCEPCION I. CASTILLANTES JULIE ANN D. APOLINARIO

Inspection Officer/Inspection Committee Supply and/or Property Custodian