Annex A Annex A

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
REGION XIII (CARAGA Region) REGION XIII (CARAGA Region)
Butuan City Butuan City

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS
Pursuant to COA Circular No. 2017-001 dated June19,2017. Pursuant to COA Circular No. 2017-001 dated June19,2017.
Name of Employee Employee No. Name of Employee Employee No.
MARY JEAN L. PANCHITO MARY JEAN L. PANCHITO
Office DILG AGUSAN DEL NORTE PROVINCIAL OFFICE Office DILG AGUSAN DEL NORTE PROVINCIAL OFFICE
Division TECHNICAL Division TECHNICAL
Particulars Amount Particulars Amount
Breakfast and Lunch on March 13, 2018 at Cabadbaran 160.00 Breakfast and Lunch on March 13, 2018 at Cabadbaran 160.00
Lunch on March 22, 2018 at Carmen 80.00 Lunch on March 22, 2018 at Carmen 80.00
Lunch on March 27, 2018 at Carmen 80.00 Lunch on March 27, 2018 at Carmen 80.00
Lunch on March 28, 2018 at Cabadbaran 80.00 Lunch on March 28, 2018 at Cabadbaran 80.00
Lunch on April 3, 2018 at Tubay 80.00 Lunch on April 3, 2018 at Tubay 80.00
Lunch on April 4, 2018 at Magallanes 80.00 Lunch on April 4, 2018 at Magallanes 80.00
Lunch on April 12, 2018 at Carmen 80.00 Lunch on April 12, 2018 at Carmen 80.00
Butuan City ot Santiago 90.00 Butuan City ot Santiago 90.00
Lunch on April 13, 2018 at Santiago 80.00 Lunch on April 13, 2018 at Santiago 80.00
Santiago to Butuan City 90.00 Santiago to Butuan City 90.00
Butuan City to Jabonga 100.00 Butuan City to Jabonga 100.00
Lunch on April 17, 2018 at Jabonga 80.00 Lunch on April 17, 2018 at Jabonga 80.00
Jabonga to Butuan City 100.00 Jabonga to Butuan City 100.00
Butuan City to Las Nieves 80.00 Butuan City to Las Nieves 80.00
Lunch on April 18, 2018 at Las Nieves 80.00 Lunch on April 18, 2018 at Las Nieves 80.00
Las Nieves to Butuan City 80.00 Las Nieves to Butuan City 80.00
Butuan City to Tubay 90.00 Butuan City to Tubay 90.00
Lunch on April 23, 2018 at Tubay 80.00 Lunch on April 23, 2018 at Tubay 80.00
Tubay to Butuan City 90.00 Tubay to Butuan City 90.00
TOTAL 1,680.00 TOTAL 1,680.00
Purpose Purpose

ADM PROJECT SITE VALIDATION AND INSPECTION, PCF 2017 SITE VALIDATION & PPOC ADM PROJECT SITE VALIDATION AND INSPECTION, PCF 2017 SITE VALIDATION & PPOC ADNOAC
ADNOAC IMMERSION IMMERSION
 I hereby certify that the above expenses are incurred as they are becessary for the above I hereby certify that the above expenses are incurred as they are becessary for the above
cited purposes, that above goods and services were acquired from the parties not issuing receipts. cited purposes, that above goods and services were acquired from the parties not issuing receipts.
And that I am fully aware that wilful falsification of statements is punishable by law. And that I am fully aware that wilful falsification of statements is punishable by law.
Certified correct: Noted by: Certified correct: Noted by:
Signature Signature

MARY CHRISTINE ANTHONETTE M. MARY CHRISTINE ANTHONETTE M. SALISE-

MARY JEAN L. PANCHITO SALISE-PUNZALAN MARY JEAN L. PANCHITO PUNZALAN
Printed Name Printed Name
Employee Immediate Supervisor Employee Immediate Supervisor
Date Date Date Date
 Annex A Annex A
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
REGION XIII (CARAGA Region) REGION XIII (CARAGA Region)
Butuan City Butuan City

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS
Pursuant to COA Circular No. 2017-001 dated June19,2017. Pursuant to COA Circular No. 2017-001 dated June19,2017.
Name of Employee Employee No. Name of Employee Employee No.
MARY JEAN L. PANCHITO MARY JEAN L. PANCHITO
Office DILG AGUSAN DEL NORTE PROVINCIAL OFFICE Office DILG AGUSAN DEL NORTE PROVINCIAL OFFICE
Division TECHNICAL Division TECHNICAL
Particulars Amount Particulars Amount
Butuan to Kitcharao 140.00 Butuan to Kitcharao 140.00
Kitcharao to Butuan 140.00 Kitcharao to Butuan 140.00
Butuan to Jabonga 100.00 Butuan to Jabonga 100.00
Jabonga to Butuan 100.00 Jabonga to Butuan 100.00
Butuan to Tubay 85.00 Butuan to Tubay 85.00
Tubay to Butuan 85.00 Tubay to Butuan 85.00
Butuan to Cabadbaran 60.00 Butuan to Cabadbaran 60.00
Cabadbaran to Butuan 60.00 Cabadbaran to Butuan 60.00
Butuan to Santiago 90.00 Butuan to Santiago 90.00
Santiago to Butuan 90.00 Santiago to Butuan 90.00
Butuan to Magallanes 70.00 Butuan to Magallanes 70.00
Magallanes to Butuan 70.00 Magallanes to Butuan 70.00
Butuan to RTR 45.00 Butuan to RTR 45.00
RTR to Butuan 45.00 RTR to Butuan 45.00

TOTAL 1,180.00 TOTAL 1,180.00

Purpose Purpose
Monitor completed locally-funded projects in Agusan del Norte Monitor completed locally-funded projects in Agusan del Norte
I hereby certify that the above expenses are incurred as they are becessary for the above I hereby certify that the above expenses are incurred as they are becessary for the above
cited purposes, that above goods and services were acquired from the parties not issuing receipts. cited purposes, that above goods and services were acquired from the parties not issuing receipts.
And that I am fully aware that wilful falsification of statements is punishable by law. And that I am fully aware that wilful falsification of statements is punishable by law.
Certified correct: Noted by: Certified correct: Noted by:
Signature Signature
Signature Signature

MARY CHRISTINE ANTHONETTE M. MARY CHRISTINE ANTHONETTE M.

MARY JEAN L. PANCHITO SALISE-PUNZALAN MARY JEAN L. PANCHITO SALISE-PUNZALAN
Printed Name Printed Name
Employee Immediate Supervisor Employee Immediate Supervisor
Date Date Date Date