Appendix 32

LIBERACION ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date : 11-28-2023
DISBURSEMENT VOUCHER Div.No, 2023-058-11-0064

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

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee JESSIE A. DE ASIS

Address BRGY. PARIL MAHAPLAG,LEYTE

Responsibility
Particulars MFO/PAP Amount
Center

To Cash advance for the Delivery EXPENSES as per supporting 1,000.00

papers hereto attched in the amount of ₱ 1000.00

Amount Due 1,000.00

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

IVY JOY C. DE ASIS

TIC

B. Accounting Entry:
Account Title UACS Code Debit Credit
Repair and Maintence-School Building 5021304002 ₱1,000.00
Cash, Modified Disbursing System, Regular 1990101000 1,000.00

C. Certified: D. Approved for Payment

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

Signature Signature

Printed
Name
ABEGAIL B. YEPEZ Printed Name IVY JOY C. DE ASIS

Position Senior Book Keeper Position Teacher-In-Charge

Date Date

E. Receipt of Payment JEV No.

Check/ Date : 11- 28 -2023 Bank Name & Account
ADA No. : 85436650 Number:DBP/ 000020637753
Date : 11- 28 -2023 Printed Name: JISSIE A. DE Date 11/28/2023
Signature :
ASIS
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: ARACELI M. GONZAGA
Sub-Office/District/Division: MAHAPLAG Official Designation: SCHOOL HEAD
Municipality/City/Province: ___________________________ Station: _______________________________________
Fund Cluster : 01 Register No. : __________________________________
Sheet No. : ____________________________________

Cash -MDS, Regular BREAKDOWN OF PAYMENTS

1010404000
DV/Payroll/
Date Particulars Amount Traveling Office OTHERS
Check/ADA No. Training
Expenses - Supplies
Expenses
Cash Local Expenses UACS Object
Payments Balance Account Description Amount
Advance Code
5020101000 5020201000 5020301000
Amount of Cash Advances Received 10,800.00 10,800.00
School -Based Feeding Program
01-08-2018 04-18-0010 Food Supplies 10,800.00 330.00 10,470.00 Water Expenses 5020401000
01-08-2018 04-18-0011 Food Supplies 180.00 10,290.00 Electricity Expenses 5020402000
01-09-2018 04-18-0012 Food Supplies 300.00 9,990.00 Security Services 5021203000
01-09-2018 04-18-0013 Food Supplies 954.00 9,036.00 Janitorial Services 5021202000
01-09-2018 04-18-0014 Food Supplies 2,807.00 6,229.00
01-11-2018 04-18-0015 Food Supplies 280.00 5,949.00 Telephone Expenses 5020502000
01-28-2018 04-18-0016 Food Supplies 1,349.00 4,600.00 Internet Subscription Expenses 5020503000
02-11-2018 04-18-0017 Food Supplies 620.00 3,980.00
02-19-2018 04-18-0018 Food Supplies 760.00 3,220.00 Repairs and Maintenance - School Buildings 5021304002
02-26-2018 04-18-0019 Food Supplies 300.00 2,920.00 Printing and Publication Expenses 5029902000
03-06-2018 04-18-0020 Food Supplies 910.00 2,010.00 Fidelity Bond Premiums 5021502000
03-06-2018 04-18-0021 Food Supplies 280.00 1,730.00
03-06-2018 04-18-0022 Food Supplies 1,730.00 -
Drugs and Medicines Expenses 5020307000
Other Maintenance and Operating Expenses 5029999000

Totals 10, 800.00 10,800.00 - - -

 Recapitulation:

Account Description UACS Object Code Amount

Traveling Expenses 5020101000 -
Training Expenses 5020201000 -
Office Supplies Expenses 5020301000 -
Food Supplies Expenses 5020305000 10,800.00
Othe Supplies and Materials Expenses 5020399000
Water Expenses 5020401000 -
Electricity Expenses 5020402000 -
Postage and Courier Services 5020501000
Telephone Expenses 5020502000 -
Internet Subscription Expenses 5020503000 -
Cable, Satellite, Telegraph and Radio Expenses 5020504000
Janitorial Services 5021202000 -
Security Services 5021203000 -
Other General Services 5021299000
Repairs and Maintenance - Land Improvements 5021302099
Repairs and Maintenance - School Buildings 5021304002 -
Repairs and Maintenance - Office Equipment 5021305002
Repairs and Maintenance - ICT 5021305003
Repairs and Maintenance - Furniture & Fixtures 5021307000
Fidelity Bond Premiums 5021502000 -
Printing and Publication Expenses 5029902000 -
Other Maintenance and Operating Expenses 5029999000

Total 10,800.00

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:

ARACELI M. GONZAGA
Signature over Printed Name Signature over Printed Name

Date: ____________________ Date: ______________________

 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:

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
LIBERACION ELEMENTARY SCHOOL
Entity Name

Supplier : AILYN JOY EATERY P.O. No. :

Address : MAHAPLAG, LEYTE 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,

__________________________ IVY JOY C. DE ASIS

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

___________________________ Teacher-In-Charge
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