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COA Form

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MARY JERICA OCUPE
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532 views2 pages

COA Form

Uploaded by

MARY JERICA OCUPE
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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Republic of the Philippines

DEPARTMENT OF EDUCATION
Region IX, Zamboanga Peninsula
Schools Division of Zamboanga del Norte
Dipolog City, 7100

ANNEX A
CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS
Pursuant to COA Circular No. 2017-001- dated June 19, 2017

Name of Employee
Employee No.
Office

Division

Particulars Amount ((₱)

TOTAL
Purpose

I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose that above
goods and services were acquired from parties not issuing receipts. And that I am fully aware that wilful falsification of
statements is punishable by law.

Certified Correct: Noted By:

Signature:
Printed Name:
Printed Name:

Employee Immediate Supervisor


Date Date

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