PETTY CASH REPLINISHMENT RE

January 1-31, 2022

ICT Office Drugs and

Training Supplies Supplies Medicine
DATE NAME OF PAYEE Voucher No. Expenses Expenses Expenses Expenses

5020309000 5020399000 5020401000 5020402000

01/29/2022 Juan de la Cruz 22-01-001
1/2/2022 Marites 22-01-002
3/2/2022 Marieta 22-01-003
4/2/2022 Marigold 22-01-004
7/2/2022 Maricor 22-01-005
ETTY CASH REPLINISHMENT REPORT
January 1-31, 2022

Fuel, Oil Other Postage & Telephone Internet Other R&M- R&M-
and Water Courier Expenses - Subscripti General
Lubricants Supplies & Expenses on
School Office
Expenses Mats. Exp. Services Mobile
Expenses
Services Building Equipment

5020501000 5020502001 5020502002 5020504000 5021003000 5021199000 5021305002 5021307000 5021501000

250.00
900.00
350.00
700.00

NIOEL I. BULAWAN
School head
Printing &
Publication TOTAL
Expenses AMOUNT

5029902000 5.03E+09
250.00
900.00
350.00
700.00
300.00 300.00

2,500.00
 Appendix 11
CHECK DISBURSEMENT RECORD

DEPARTMENT OF EDUCATION
Agency
Entity Name: POTOT ELEMENTARY SCHOOL
Fund Cluster: 01-MOOE Sheet No. 1

Accountable Officer Designation Station

Check NCA Received/ Bank/ NCA
Date Name of Payee Nature of Payment
No. Date Released Deposit made Checks Issued Balance
143,750.00
7/2/2025 94834182 7/2/2025 LEA MAE F. ARINTOK Payment for electricity expense 8,153.00 135,597.00
Payment for gasoline for mower 135,097.00
7/2/2025 94834183 7/2/2025 LEA MAE F. ARINTOK 500.00
Payment for other general services 1,800.00
133,297.00
Payment for janitorial services 1,200.00 132,097.00
Payment for security services 2,500.00 129,597.00
7/2/2025 94834184 7/2/2025 INNOVE COMMUNICATIONS INC. Payment for internet subscription expense 2,896.00 126,701.00
7/2/2025 94834185 7/2/2025 CANCELLED
7/2/2025 94834186 7/2/2025 LEA MAE F. ARINTOK Payment for reimbursement for internet 1,398.00 125,303.00
02/19/2025 94834187 02/19/2025 SBFP subscription expense
02/19/2025 94834188 02/19/2025 LEA MAE F. ARINTOK Payment for reimbursement for office supplies 2,200.00 123,103.00
02/19/2025 94834189 02/19/2025 LEA MAE F. ARINTOK expense
Payment for travel expense 1,150.00 121,953.00
02/19/2025 94834190 02/19/2025 LEA MAE F. ARINTOK Payment for gasoline for mower 400.00 121,553.00
Payment for other general services 1,800.00 119,753.00
Payment for janitorial services 1,200.00 118,553.00
Payment for security services 2,500.00 116,053.00
Payment for the procurement of 2 pcs 43 inch
02/21/2025 94834191 02/21/2025 DU EK SAM, INC. SHARP Google TV 30,598.00 85,455.00
02/21/2025 94834192 02/21/2025 SBFP
02/21/2025 94834193 02/21/2025 SBFP
02/21/2025 94834194 02/21/2025 UPSON INTERNATIONAL CORP. Payment for the procurement of 2 pcs HDMI 858.00 84,597.00
94834195 CANCELLED
94834196 CANCELLED
 94834197 CANCELLED
94834198 CANCELLED
94834199 CANCELLED
WENZHUAN MARKETING
02/21/2025 94834200 02/21/2025 CORPORATION Payment for office supplies expense 2,885.00 81,712.00
02/23/2025 97662401 02/23/2025 GYLE'S VARIETY STORE Payment for other supplies and materials expense 10,440.00 71,272.00
02/23/2025 97662402 02/23/2025 GYLE'S VARIETY STORE Payment for office supplies expense 27,385.00 43,887.00
97662403 SBFP
97662404 SBFP
Payment for reimbursement for printing and
02/28/2025 97662405 02/28/2025 LEA MAE F. ARINTOK publication expense 1576.56 42,310.44

CERTIFICATION
I hereby certify that the foregoing is the correct and complete record of all checks issuesd by me in my capacity School
as ______________________ of _________________________ during the period from _________________ to ______________________, inclusive, as indicated in the
corresponding column.

LEA MAE F. ARINTOK

School Head
__________________________
Date
 REPORT OF CHECK ISSUED
Period covered: January 2025

Entity Name:POTOT ELEMENTARY SCHOOL

Fund Cluster: 01- MOOE
Bank Name/ Account Number: DBP/ 00-0-05763-765-8
Check DV/PAYROLL ORS/ BURS
Responsibility center
code
Date No. No. No.

01/26/2025 94834177 2025-01-004

CERTIFICATION
I hereby certify on my official oath that this Report of Checks Issued in 1 sheet(s) is a full,
statement of all checks issued by me during the period stated above for which Check Nos
inclusive, were actually issued by me in the amounts shown thereon.
 Apendix 35

REPORT OF CHECK ISSUED

Period covered: January 2025

Report No.: 01
Sheet No: 01
Payee UACS Object Code Nature of Payment Amount

GYLE'S VARIETY STORE 5020301000 Office Supplies Expense 1,796.33

CERTIFICATION
my official oath that this Report of Checks Issued in 1 sheet(s) is a full, true and correct
hecks issued by me during the period stated above for which Check Nos. 0094834177
inclusive, were actually issued by me in the amounts shown thereon.

LEA MAE F. ARINTOK

School Head
__________________________
Date
 Department of Education
Potot Elementary School
Capoocan II District
Capoocan, Leyte

LIQUIDATION REPORT
MOOE

LR No. : Year-district code-month-sequence no

School ID No. : 121248 Date : Date of preparation

PARTICULARS
Account Title Account Code AMOUNT TOTAL AMOUNT
Travelling Expenses - Local 5020101000
ICT Training Expenses 5020201001
Training Expenses 5020201002
ICT-Office Supplies Expenses 5020301001
Office Supplies Expenses 5020301000
Food Expenses 5020305000
Drugs and Medicines Expenses 5020307000
Fuel, Oil and Lubricants Expenses 5020309000
Other Supplies and Materials expenses 5020399000
Water Expenses 5020401000
Electricity Expenses 5020402000
Postage and Courier Services 5020501000
Telephone Expenses-Mobile 5020502001
Telephone Expenses-Landline 5020502002 Division Liquidation b

Internet Subscription Expense 5020503000 Sr. Bookkeeper

Cable, satelite, telegraph & radio expense 5020504000 School Liquidation bu

Extraordinaty and Miscellaneous Expenses 5020103000 School's Transparency

Legal Services 5021101000 MOVs

Other Professional Services 5021199000

Janitorial Services 5021202000
Security Services 5021203000
Other General Services 5021299000 10,206.00 10,206.00
Repair and Maintenance - Land Improvement 5021302000
Repair and Maintenance - School Building 5021304002
Repair and Maintenance - Office Equipment 5021305002
Repair and Maintenance - ICT Equipment 5021305003
Repair and Maintenance - Machinery and Equipment 5021305000
Repair and Maintenance - Furnitures and Fixtures 5021307000
Taxes, Duties & Licenses 5021501000
Fidelity Bond Premiums 5021502000
Agricultutal and Marine supplies Expenses 5020310000
Printing & Publication Expenses 5029902000
Transportation and delivery Expenses 5029904000
Other Maintenance and Operating Expenses 5029999000
TOTAL AMOUNT 10,206.00
ADA No. : 24-04-33M Date: 4/12/2024 Amount 10,206.00
Total Amount of Cash Advance 15,552.00
Less: Amount Spent P 10,206.00
Unliquidated Balance P 5,346.00
Due to:____________________________________________________

Correctness : Transaction/Activity under my supervision : Documents Complete:

NOEL I. BULAWAN MARISA G. MARTILLO DONAH V. ORTEGA AMIEL DENNIS B. ALLADO

School Head District Supervisor Senior Bookkeeper Division Accountant
sequence no.

ion Liquidation bundle (Original)

ookkeeper

ol Liquidation bundle (Photocopy)

ol's Transparency Board

 Appendix 43

CASH DISBURSEMENTS REGISTER

Entity Name : POTOT ELEMENTARY SCHOOL Name of Accountable Officer : LEA MAE F. ARINTOK
Sub-Office/District/Division : Capoocan II District Official Designation : T-III/TIC
Municipality/City/Province : Capoocan, Leyte Station : Potot, Capoocan, Leyte
Fund Cluster : 01 - MOOE Register No. :
Sheet No. :
Advances for
Operating Expenses BREAKDOWN OF PAYMENTS
(19901010)
DV/Payroll/ Check Amount OTHERS
Date Particulars Internet
No. Payments Other Supplies Office Supplies
Petty Cash Subscription
and Materials Expenses
Cash Expense
Account Description
UACS Object
Amount
Balance Code
Advance
1010102000 5020503000 5020399000 5020301000

02/03/2025 ADA# 2501012 CA for the School MOOE January-March, 2025 143,750.00 143,750.00
02/07/25 2025-02-001/ 0094834182 Payment for electricity expense 8,153.00 135,597.00 Electricity Expense 5020402000 8,153.00
02/07/25 2025-02-002/ 0094834183 Payment for gasoline for mower 500.00 135,097.00 Fuel, Oil and Lubricants Exps. 5020309000 500.00
Payment for other general services 1,800.00 133,297.00 Other General Services 5021299000 1,800.00
Payment for janitorial services 1,200.00 132,097.00 Janitorial Services 5021202000 1,200.00
Payment for security services 2,500.00 129,597.00 Security Services 5021203000 2,500.00
02/07/25 2025-02-003/ 0094834184 Payment for internet subscription expense 2,896.00 126,701.00 Internet Subscription Expense 5020503000 2,896.00
02/07/25 2025-02-004/ 0094834186 Payment for reimbursement of internet subscription 1,398.00 125,303.00
expense Internet Subscription Expense 5020503000 1,398.00
02/19/25 2025-02-005/ 0094834188 Payment for reimbursement of office supplies expense 2,200.00 123,103.00 Office Supplies Expense 5020301000 2,200.00
02/19/25 2025-02-006/ 0094834189 Payment for travel expense for the reorientation of CSM 1,150.00 121,953.00 Travelling Expenses-Local
and SBM for all School Heads 5020101000 1,150.00
02/19/25 2025-02-007/ 0094834190 Payment for gasoline for mower 400.00 119,053.00 Fuel, Oil and Lubricants Exps. 5020309000 400.00
Payment for other general services 1,800.00 117,253.00 Other General Services 5021299000 1,800.00
Payment for janitorial services 1,200.00 116,053.00 Janitorial Services 5021202000 1,200.00
Payment for security services 2,500.00 113,553.00 Security Services 5021203000 2,500.00
02/21/25 2025-02-008/ 0094834191 Payment for the procurement of 2 pcs 43 inch SHARP 30,598.00 75,455.00 Other Supplies and Materials Expense
Google TV 5020399000 30,598.00
02/21/25 2025-02-009/ 0094834194 Payment for the procurement of 2 pcs HDMI 858.00 74,597.00 Other Supplies and Materials Expense
5020399000 858.00
02/21/25 2025-02-0010/ 0094834200 Payment for office supplies expense 2,885.00 71,712.00 Office Supplies Expense 5020301000 2,885.00
02/23/25 2025-02-0011/ 0097662401 Payment for other supplies and materials expense 10,440.00 64,157.00 Other Supplies and Materials Expense
5020399000 10,440.00
02/23/25 2025-02-0012/ 0097662402 Payment for office supplies expense 27,385.00 44,327.00 Office Supplies Expense 5020301000 27,385.00

02/28/25 2025-02-0013/ 0097662405 Payment for reimbursement of printing and publication 1,576.56 62,580.44 Printing and Publication Expense 5029902000
expense 1,576.56
 Totals 111,439.56 - - - 111,439.56
Recapitulation:
Petty Cash 1010102000
Electricity Expense 5020402000 8,153.00
Fuel, Oil and Lubricants Exps. 5020309000 500.00
Other General Services 5021299000 1,800.00
Janitorial Services 5021202000 1,200.00
Security Services 5021203000 2,500.00
Internet Subscription Expense 5020503000 2,896.00
Internet Subscription Expense 5020503000 1,398.00
Office Supplies Expense 5020301000 2,200.00
Travelling Expenses-Local 5020101000 1,150.00
Fuel, Oil and Lubricants Exps. 5020309000 400.00
Other General Services 5021299000 1,800.00
Janitorial Services 5021202000 1,200.00
Security Services 5021203000 2,500.00
Other Supplies and Materials Expense 5020399000 30,598.00
Other Supplies and Materials Expense 5020399000 858.00
Office Supplies Expense 5020301000 2,885.00
Other Supplies and Materials Expense 5020399000 10,440.00
Office Supplies Expense 5020301000 27,385.00
Printing and Publication Expense 5029902000 1,576.56
TOTAL 111,439.56

CERTIFIED CORRECT: RECEIVED BY :

LEA MAE F. ARINTOK FATIMA M. VERTUDES

School Head Senior Bookkeeper
Date : Date :
 LIQUIDATION REPORT
(MOOE)
For the month of August 2021

LR No :
Date :

Name of School: BARAS ELEMENTARY SCHOOL

PARTICULARS
Account Title UACS Object Code Amount Total Amount
Travelling Expenses (Local) 5020101000
ICT Training Expenses 5020201001
Training Expenses 5020201002
ICT Office Supplies Expenses 5020301001
Office Supplies Expenses 5020301002
Food Supplies Expenses (SBFP) 5020305000
Drugs & Medicines Expenses 5020307000
Fuel, Oil and Lubricants 5020309000
Other Supplies Expenses 5020399000
Water Expenses 5020401000
Electricity Expenses 5020402000
Postage & Courier Expenses 5020501000
Telephone Expenses (Mobile) 5020502001
Telephone Expenses (Landline) 5020502002
Internet Subscription Expenses 5020503000
Cable, Satellite, Telegraph & Radio Expenses 5020503000
Other Professional Services 5021199000
Janitorial Expenses 5021202000
Security Expenses 5021203000
Other General Services 5021299099
Repair & Maintenance - Land Improvements 5021302099
Repair & Maintenance - Other Land & Improvements 5021302000
Repair & Maintenance - School Bldg & Other Structures 5021304002
Repair & Maintenance - Machinery & Equipment 5021305001
Repair & Maintenance - ICT Equipment 5021305003
Repair & Maintenance - Office Equipment 5021305002
Repair & Maintenance - Furniture & Fixtures 5021307000
Transportation & Delivery Expenses 5029904000
Fidelity Bond Premiums 5021502000
Extraordinary & Miscellaneous Expenses 5021003000
Printing & Publication Expenses 5029902000
Other Maintenance & Operating Expenses 5029999002
TOTAL AMOUNT Php -

Check No. Check Date: Amount Php 42,196.00

Total Amount of Cash Advance P 42,196.00
Less: Amount Spent P -
Unliquidated Balance P 42,196.00

Correctness of Check: Transaction/Acitivity under my Documents Complete:

supervision

NOEL I. BULAWAN MARISA G. MARTILLO DONAH V. ORTEGA AMIEL DENNIS B. ALLADO

Claimant District Supervisor Senior Bookkeeper Division Accountant
 Appendix 32

BARAS ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date : 8/13/2021
DISBURSEMENT VOUCHER
DV No. : 21-08-000

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

Payment
_________________

Payee Elsa M. De Paz TIN/Employee No.: ORS/BURS No.:

Address Palo, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment of various office supplies for Baras ES' teachers
use as per receipt and other supporting papers hereto attached.
5,000.00

Amount Due 5,000.00

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

NOEL I. BULAWAN
Princpial I

B. Accounting Entry :
Account Title UACS Code Debit Credit

Office Supplies Expenses 5020301000 5,000.00

Cash, Modified Disbursement System - Regular 1010404000 5,000.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name NOEL I. BULAWAN

Position ADAS III (Senior Bookkeeper) Position Princpial I
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents : OR#123456/August 13, 2021

 Appendix 32

BARAS ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date :
DISBURSEMENT VOUCHER
DV No. :

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

Payment
_________________

Payee NATIONAL BOOKSTORE TIN/Employee No.: ORS/BURS No.:

Address Tacloban, City

Responsibility
Particulars Center
MFO/PAP Amount
To record payment of stapler, trashcan, etc. for Baras ES' staff use as
per receipt and other supporting papers hereto attached.
400.00

Amount Due 400.00

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

NOEL I. BULAWAN
Princpial I

B. Accounting Entry :
Account Title UACS Code Debit Credit

Other Supplies and Materials Expenses 5020399000 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name NOEL I. BULAWAN

Position ADAS III (Senior Bookkeeper) Position Princpial I
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

BARAS ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date : 3/8/2019
DISBURSEMENT VOUCHER
DV No. : 19-47-03-008

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

Payment
_________________

Payee R & B Tours TIN/Employee No.: ORS/BURS No.:

Address Merida, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment for the freight and handling of various supplies
from Ormoc, City to Capoocan, Leyte as per receipt and other
supporting papers hereto attached. 400.00

Amount Due 400.00

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

NOEL I. BULAWAN
Princpial I

B. Accounting Entry :
Account Title UACS Code Debit Credit

Other Maintenance and Operating Expenses 5029999000 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name NOEL I. BULAWAN

Position ADAS III (Senior Bookkeeper) Position Princpial I
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

POTOT ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date :
DISBURSEMENT VOUCHER
DV No. :

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

Payment
_________________

Payee DEPED LEYTE DIVISION TIN/Employee No.: ORS/BURS No.:

Address Leyte Division Office, Candahug Palo, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment for the registration fee for the conduct of Division
Management Committee Meeting which shall be held on June 19-20, 2023
at the Leyte Academic Center, Brgy. Pawing Palo, Leyte as per receipt 1,200.00
and other supporting paper hereto attached.

Amount Due 1,200.00

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

LEA MAE F. ARINTOK

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Training Expenses 5020201002 1,200.00

Cash, Modified Disbursement System - Regular 1010404000 1,200.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name MARITES C. CAPAYCAPAY FATIMA M. VERTUDES Printed Name LEA MAE F. ARINTOK
Disbursing Officer-Designate ADAS IIIS (Senior
Position Bookkeeper) Position School Head

Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : Number:
Date : Printed Name: Date
Signature :
 Printed Name:
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

POTOT ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date :
DISBURSEMENT VOUCHER
DV No. :

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

Payment
_________________

Payee ROMEO C. GUZMAN TIN/Employee No.: ORS/BURS No.:

Address Palo, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment of travel expenses incurred in going to Leyte
Division Office to submit various reports last August 21, 2021 as per
travel order and other supporting papers hereto attached. 400.00

Amount Due 400.00

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

LEA MAE F. ARINTOK

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Travelling Expenses - Local 5020101000 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name LEA MAE F. ARINTOK

Position ADAS III (Senior Bookkeeper) Position School Head
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

POTOT ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date :
DISBURSEMENT VOUCHER
DV No. :

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

Payment
_________________

Payee Leyeco II TIN/Employee No.: ORS/BURS No.:

Address Tacloban, City

Responsibility
Particulars Center
MFO/PAP Amount
To record payment of water consumption for the month of August,
2021 as per receipt and other supporting paper hereto attached.
400.00

Amount Due 400.00

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

LEA MAE F. ARINTOK

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Water Expenses 5020401000 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name LEA MAE F. ARINTOK

Position ADAS III (Senior Bookkeeper) Position School Head
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

POTOT ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date :
DISBURSEMENT VOUCHER
DV No. :

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

Payment
_________________

Payee LEYECO V TIN/Employee No.: ORS/BURS No.:

Address Capoocan, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment of electric consumption for the month of August,
2021 as per receipt and other supporting paper hereto attached.
400.00

Amount Due 400.00

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

LEA MAE F. ARINTOK

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Electricity Expenses 5020402000 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name LEA MAE F. ARINTOK

Position ADAS III (Senior Bookkeeper) Position School Head
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

POTOT ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date :
DISBURSEMENT VOUCHER
DV No. :

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

Payment
_________________

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

Address Capoocan, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment of internet bill for the month of August, 2021 as
per receipt and other supporting paper hereto attached.
400.00

Amount Due 400.00

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

LEA MAE F. ARINTOK

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Internet Subscription Expenses 5020503000 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name LEA MAE F. ARINTOK

Position ADAS III (Senior Bookkeeper) Position School Head
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

POTOT ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date :
DISBURSEMENT VOUCHER
DV No. :

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

Payment
_________________

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

Address Capoocan, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment of internet load for the month of August, 2018 as
per receipt and other supporting paper hereto attached.
400.00

Amount Due 400.00

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

LEA MAE F. ARINTOK

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Internet Subscription Expenses 5020503000 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name LEA MAE F. ARINTOK

Position ADAS III (Senior Bookkeeper) Position School Head
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

POTOT ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date :
DISBURSEMENT VOUCHER
DV No. :

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

Payment
_________________

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

Address Capoocan, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment of celphone load for the month of August, 2021
as per receipt and other supporting paper hereto attached.
400.00

Amount Due 400.00

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

LEA MAE F. ARINTOK

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Telephone Expenses - Mobile 5020402000 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name LEA MAE F. ARINTOK

Position ADAS III (Senior Bookkeeper) Position School Head
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

POTOT ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date :
DISBURSEMENT VOUCHER
DV No. :

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

Payment
_________________

Payee APOLINARIO MALAPIT TIN/Employee No.: ORS/BURS No.:

Address Capoocan, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment of security guard for the month of August, 2021
as per acknowledgement receipt and other supporting paper hereto
attached. 400.00

Amount Due 400.00

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

LEA MAE F. ARINTOK

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Security Services 5021203000 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name LEA MAE F. ARINTOK

Position ADAS III (Senior Bookkeeper) Position School Head
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

POTOT ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date :
DISBURSEMENT VOUCHER
DV No. :

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

Payment
_________________

Payee JUAN MAGDADARO TIN/Employee No.: ORS/BURS No.:

Address Capoocan, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment for grasscutting of school plaza, watering of plants,
cleaning the whole school premises for the month of August, 2021 as
per acknowledgement receipt and other supporting paper hereto 400.00
attached.

Amount Due 400.00

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

LEA MAE F. ARINTOK

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Janitorial Services 5021202000 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name LEA MAE F. ARINTOK

Position ADAS III (Senior Bookkeeper) Position School Head
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

POTOT ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date :
DISBURSEMENT VOUCHER
DV No. :

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

Payment
_________________

Payee H & F SHOP TIN/Employee No.: ORS/BURS No.:

Address Capoocan, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment of sound system rental to be used for the
graduation ceremony of Baras ES as per receipt and other supporting
paper hereto attached. 400.00

Amount Due 400.00

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

LEA MAE F. ARINTOK

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Other General Services 5021299000 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name LEA MAE F. ARINTOK

Position ADAS III (Senior Bookkeeper) Position School Head
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

POTOT ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date :
DISBURSEMENT VOUCHER
DV No. :

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

Payment
_________________

Payee BUREAU OF INTERNAL REVENUE TIN/Employee No.: ORS/BURS No.:

Address Ormoc, City

Responsibility
Particulars Center
MFO/PAP Amount
To record payment of documentary stamps for diploma of graduating
pupil's use as per stamps and other supporting paper hereto attached.
400.00

Amount Due 400.00

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

LEA MAE F. ARINTOK

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Other Supplies and Materials Expenses 5020399000 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name LEA MAE F. ARINTOK

Position ADAS III (Senior Bookkeeper) Position School Head
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

POTOT ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date :
DISBURSEMENT VOUCHER
DV No. :

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

Payment
_________________

Payee BUREAU OF TREASURY TIN/Employee No.: ORS/BURS No.:

Address Tacloban, City

Responsibility
Particulars Center
MFO/PAP Amount
To record payment of cash bond for the year 2021 as per ATAP
and other supporting paper hereto attached.
400.00

Amount Due 400.00

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

LEA MAE F. ARINTOK

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Fidelity Bond Premiums 5021502000 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name LEA MAE F. ARINTOK

Position ADAS III (Senior Bookkeeper) Position School Head
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

LIBERTAD ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date :
DISBURSEMENT VOUCHER
DV No. :

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

Payment
_________________

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

Address

Responsibility
Particulars Center
MFO/PAP Amount
To record payment for printing of School ID as per receipt and other
supporting paper hereto attached.

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

MA. SHIELA C. PILANDE

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Printing and Publication Expenses 5029902000

Cash, Modified Disbursement System - Regular 1010404000

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name MERADER B. PUNAY FATIMA M. VERTUDES Printed Name MA. SHIELA C. PILANDE
Position Disbursing Officer-Designate ADAS III (Senior Bookkeeper) Position School Head

Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : Number:
Date : Printed Name: Date
Signature :
 Printed Name:
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

LIBERTAD ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date :
DISBURSEMENT VOUCHER
DV No. :

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

Payment
_________________

Payee ASL ENTERPRISES TIN/Employee No.: ORS/BURS No.:

Address Capoocan, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment of various materials for stage rehabilitation as per
receipt and other supporting paper hereto attached.
400.00

Amount Due 400.00

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

MA. SHIELA C. PILANDE

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Repair and Maintenance - School Building 5021304002 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name MA. SHIELA C. PILANDE

Position ADAS III (Senior Bookkeeper) Position School Head
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents : OR# 023123/July 1, 2019

 Appendix 32

LIBERTAD ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date : 3/8/2019
DISBURSEMENT VOUCHER
DV No. : 19-47-03-008

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

Payment
_________________

Payee ASL ENTERPRISES TIN/Employee No.: ORS/BURS No.:

Address Palompon, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment of various materials for repair of school perimeter
fence as per receipt and other supporting paper hereto attached.
400.00

Amount Due 400.00

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

MA. SHIELA C. PILANDE

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Repair and Maintenance - School Building 5021304002 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name MA. SHIELA C. PILANDE

Position ADAS III (Senior Bookkeeper) Position School Head
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

LIBERTAD ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date : 3/8/2019
DISBURSEMENT VOUCHER
DV No. : 19-47-03-008

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

Payment
_________________

Payee MARIO GONZALES TIN/Employee No.: ORS/BURS No.:

Address Palompon, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment of labor for the stage rehabilitation as per
acknowledgement receipt and other supporting paper hereto attached.
400.00

Amount Due 400.00

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

MA. SHIELA C. PILANDE

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Repair and Maintenance - School Building 5021304002 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name MA. SHIELA C. PILANDE

Position ADAS III (Senior Bookkeeper) Position School Head
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

LIBERTAD ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date : 3/8/2019
DISBURSEMENT VOUCHER
DV No. : 19-47-03-008

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

Payment
_________________

Payee ANTONIO MIRALLES TIN/Employee No.: ORS/BURS No.:

Address Palompon, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment of labor for the repair of school perimeter fence
as per receipt and other supporting paper hereto attached.
400.00

Amount Due 400.00

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

MA. SHIELA C. PILANDE

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Repair and Maintenance - School Building 5021304002 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name MA. SHIELA C. PILANDE

Position ADAS III (Senior Bookkeeper) Position School Head
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

LIBERTAD ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date : 3/8/2019
DISBURSEMENT VOUCHER
DV No. : 19-47-03-008

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

Payment
_________________

Payee ASL ENTERPRISES TIN/Employee No.: ORS/BURS No.:

Address Palompon, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment for the repair of Epson L-210 printer as per
receipt and other supporting paper hereto attached.
400.00

Amount Due 400.00

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

MA. SHIELA C. PILANDE

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Repair and Maintenance - Office Equipment 5021321001 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name MA. SHIELA C. PILANDE

Position ADAS III (Senior Bookkeeper) Position School Head
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

LIBERTAD ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date : 3/8/2019
DISBURSEMENT VOUCHER
DV No. : 19-47-03-008

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

Payment
_________________

Payee ASL ENTERPRISES TIN/Employee No.: ORS/BURS No.:

Address Palompon, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment for the repair of one unit aircon as per receipt
and other supporting paper hereto attached.
400.00

Amount Due 400.00

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

MA. SHIELA C. PILANDE

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Repair and Maintenance - Office Equipment 5021321001 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name MA. SHIELA C. PILANDE

Position ADAS III (Senior Bookkeeper) Position School Head
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

LIBERTAD ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date : 3/8/2019
DISBURSEMENT VOUCHER
DV No. : 19-47-03-008

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

Payment
_________________

Payee ASL ENTERPRISES TIN/Employee No.: ORS/BURS No.:

Address Palompon, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment for the repair of filing cabinet as per receipt and
other supporting paper hereto attached.
400.00

Amount Due 400.00

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

MA. SHIELA C. PILANDE

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Repair and Maintenance - Furnoitures and fixtures 5021322000 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name MA. SHIELA C. PILANDE

Position ADAS III (Senior Bookkeeper) Position School Head
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

LIBERTAD ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date : 3/8/2019
DISBURSEMENT VOUCHER
DV No. : 19-47-03-008

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

Payment
_________________

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

Address Palompon, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment for mailing fee of form 78 as per receipt and
other supporting paper hereto attached.
693.00

Amount Due 693.00

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

MA. SHIELA C. PILANDE

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Postage and Courier Services 5020501000 693.00

Cash, Modified Disbursement System - Regular 1010404000 693.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name MA. SHIELA C. PILANDE

Position ADAS III (Senior Bookkeeper) Position School Head
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 21-08-081M AUGUST 11, 2021 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

LIBERTAD ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date :
DISBURSEMENT VOUCHER
DV No. :

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

Payment
_________________

Payee MA. LOURDES V. YBAÑEZ TIN/Employee No.: ORS/BURS No.:

Address Capoocan, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment of _______________________________________
as per receipt and other supporting paper hereto attached.
400.00

Amount Due 400.00

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

MA. SHIELA C. PILANDE

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Extra-ordinary and Miscellaneous Expenses 5020103000 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name MA. SHIELA C. PILANDE

Position ADAS III (Senior Bookkeeper) Position School Head
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 18-10-138M October 10, 2018 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

LIBERTY ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date : 9/25/2018
DISBURSEMENT VOUCHER
DV No. : 18-47-09-119

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

Payment
_________________

Payee ASL ENTERPRISES TIN/Employee No.: ORS/BURS No.:

Address Palompon, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment of contribution for the World's Teachers Day
Celebration as per receipt and other supporting paper hereto attached.
400.00

Amount Due 400.00

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

ROMEO C. GUZMAN
Head Teacher III

B. Accounting Entry :
Account Title UACS Code Debit Credit

Extra-ordinary and Miscellaneous Expenses 5020103000 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name JHOANA MARIS V. LONDON MARIA ANA M. ANTANG Printed Name ROMEO C. GUZMAN
Position Disbursing Officer ADAS III (Senior Bookkeeper) Position Head Teacher III
Date September 25, 2018 September 25, 2018 Date September 25, 2018
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 18-09-116M September 10, 2018 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

LIBERTY ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date : 9/25/2018
DISBURSEMENT VOUCHER
DV No. : 18-47-09-119

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

Payment
_________________

Payee ASL ENTERPRISES TIN/Employee No.: ORS/BURS No.:

Address Palompon, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment of contribution for the World's Teachers Day
Celebration as per receipt and other supporting paper hereto attached.
400.00

Amount Due 400.00

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

ROMEO C. GUZMAN
Head Teacher III

B. Accounting Entry :
Account Title UACS Code Debit Credit

Extra-ordinary and Miscellaneous Expenses 5020103000 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name JHOANA MARIS V. LONDON MARIA ANA M. ANTANG Printed Name ROMEO C. GUZMAN
Position Disbursing Officer ADAS III (Senior Bookkeeper) Position Head Teacher III
Date September 25, 2018 September 25, 2018 Date September 25, 2018
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 18-09-116M September 10, 2018 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Appendix 32

LIBERTAD ELEMENTARY SCHOOL Fund Cluster : 01

Entity Name
Date :
DISBURSEMENT VOUCHER
DV No. :

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

Payment
_________________

Payee ROMEO C. GUZMAN TIN/Employee No.: ORS/BURS No.:

Address Capoocan, Leyte

Responsibility
Particulars Center
MFO/PAP Amount
To record payment of ____________________________________ as
per receipt and other supporting papers hereto attached.
400.00

Amount Due 400.00

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

MA. SHIELA C. PILANDE

School Head

B. Accounting Entry :
Account Title UACS Code Debit Credit

Training Expenses 5020201002 400.00

Cash, Modified Disbursement System - Regular 1010404000 400.00

C. Certified : D. Approved for Payment

√ Cash available
Subject to Authority to Debit Account (when applicable)
√ Suppor

Signature Signature

Printed Name DONAH V. ORTEGA Printed Name MA. SHIELA C. PILANDE

Position ADAS III (Senior Bookkeeper) Position School Head
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account
No. : 18-09-116M September 10, 2018 Number:
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents :

 Republic of the Philippines
Department of Education
Region VIII (Eastern Visayas)
DIVISION OF LEYTE
PALO III DISTRICT
Palo, Leyte

LIBERTAD ELEMENTARY SCHOOL

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 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region VIII (Eastern Visayas)
DIVISION OF LEYTE
PALO III DISTRICT
Palo, Leyte

July 29, 2019

AUTHORITY TO TRAVEL
TRAVEL ORDER
NO.

Name NOEL I. BULAWAN

Position School Head
Division DepEd Leyte Division
Place/Destination Tanauan School of Craftsmanship & Home Industries, Tanauan, Leyte
Date October 30-31, 2018
Objective/s Name of activityTo attend/compete to the "2018 Division
Technolympics" both Elementary & Secondary Skills
Competition.
Role :
Nature of Travel (√) Official Business
( ) Official Time
( ) On Leave (Personal Travel)
Legal Basis ( ) DepEd Order
(√) DepEd Memorandum # 453 dated August 24, 2018
( ) Others
Fund Source ( ) National Fund
( ) Local Fund
(√) Others (MOOE)
Use of Vehicle ( ) with government vehicle
(√) without government vehicle
Registration Fee (√) with registration fee
( ) without registration fee

Approved by :

MARISA G. MARTILLO
Public Schools District Supervisor
 Republic of the Philippines
Department of Education
Region VIII (Eastern Visayas)
Division of Leyte
Candahug Palo, Leyte

ITINERARY OF TRAVEL

Name : NOEL I. BULAWAN

Position : School Head
Official Station : Cabul-an Elementary School

Purpose of trave
: To attend/compete to the "2018 Division Technolympics" both Elementary &
Secondary Skills Competition.

TIME Means of Per

Date Places to be visited Fare Others Totals
Departure Arrival Transpo. Diems
July 2, 2018Isabel, Leyte - Ormoc, City 6:38 am 7:42 am VAN 70.00 70.00
Ormoc, City - Palo, Leyte 8:35 am 10:58 am VAN 130.00 130.00
Palo, Leyte - Ormoc, City 2:38pm 5:04 pm VAN 130.00 130.00
Ormoc, City - Isabel, Leyte 5:32 pm 6:46 pm VAN 70.00 320.00 390.00
-
-
-

TOTAL 400.00 320.00 - 720.00

-
(2.) I certify that : (a) I have received the foregoing (1.) Prepared by :
Itinerary, (b) the travel is necessary to the service
and the service period covered is reasonable,
and the expenses claimed are proper. NOEL I. BULAWAN
School Head

(3.) Approved by :

MARISA G. MARTILLO MARISA G. MARTILLO

Public Schools District Supervisor Public Schools District Supervisor

Republic of the Philippines

Department of Education
 Region VIII (Eastern Visayas)
Division of Leyte
Candahug Palo, Leyte

ITINERARY OF TRAVEL

Name : JHOANA MARIS V. LONDON

Position : Teacher III
Official Station : Cabul-an Elementary School

Purpose of trave
: To attend/compete to the "2018 Division Technolympics" both Elementary &
Secondary Skills Competition.

TIME Means of Per

Date Places to be visited Fare Others Totals
Departure Arrival Transpo. Diems
July 2, 2018Isabel, Leyte - Ormoc, City 6:38 am 7:42 am VAN 70.00 70.00
Ormoc, City - Palo, Leyte 8:35 am 10:58 am VAN 130.00 130.00
Palo, Leyte - Ormoc, City 2:38pm 5:04 pm VAN 130.00 130.00
Ormoc, City - Isabel, Leyte 5:32 pm 6:46 pm VAN 70.00 320.00 390.00
-
-
-

TOTAL 400.00 320.00 - 720.00

-
(2.) I certify that : (a) I have received the foregoing (1.) Prepared by :
Itinerary, (b) the travel is necessary to the service
and the service period covered is reasonable,
and the expenses claimed are proper. JHOANA MARIS V. LONDON
Teacher III

(3.) Approved by :

NOEL I. BULAWAN MARISA G. MARTILLO

School Head Public Schools District Supervisor
 Republic of the Philippines
Department of Education
Region VIII (Eastern Visayas)
Division of Leyte
Candahug Palo, Leyte

CERTIFICATION OF TRAVEL COMPLETED

MARISA G. MARTILLO Palompon South District

Department Head Station

Public Schools District Supervisor Palompon, Leyte

Designation Address

I CERTIFY that I have completed the travel authorized in

Itinerary of Travel Order No. _2018-09-007 , dated June 29, 2018__ , under
conditions indicated below :
Strictly in accordance with the approved itinerary.
Cut short as explained below. Excess payment in the amount
of P , was refunded under OR No. _____________
dated ___________________.
Extended as explained below. Additional itinerary was
submitted.
Other deviations as explained below.

Explanation or Specifications : ________________________________________

_____________________________________________________________________
_____________________________________________________________________

Evidences of Travel ;

Used tickets
Certificate of Appearance
Others : _ __ __________
______________________

Respectfully Submitted :

NOEL I. BULAWAN
School Head

On evidence and information of which I have knowledge,

the travel was actually undertaken.

MARISA G. MARTILLO
Public Schools District Supervisor

Republic of the Philippines

Department of Education
 Region VIII (Eastern Visayas)
Division of Leyte
Candahug Palo, Leyte

CERTIFICATION OF TRAVEL COMPLETED

NOEL I. BULAWAN Baras Elementary School

Department Head Station

School Head Palo, Leyte

Designation Address

I CERTIFY that I have completed the travel authorized in

Itinerary of Travel Order No. _2018-09-007 , dated June 29, 2018__ , under
conditions indicated below :
Strictly in accordance with the approved itinerary.
Cut short as explained below. Excess payment in the amount
of P , was refunded under OR No. _____________
dated ___________________.
Extended as explained below. Additional itinerary was
submitted.
Other deviations as explained below.

Explanation or Specifications : ________________________________________

_____________________________________________________________________
_____________________________________________________________________

Evidences of Travel ;

Used tickets
Certificate of Appearance
Others : _ __ __________
______________________

Respectfully Submitted :

JHOANA MARIS V. LONDON

Teacher III

On evidence and information of which I have knowledge,

the travel was actually undertaken.

NOEL I. BULAWAN
School Head
 Appendix 60

PURCHASE REQUEST
Entity Name : BARAS ELEMENTARY SCHOOL Fund Cluster : 01 - MOOE

Office/Section : ____________ PR No. : 2021-08-001 Date: AUGUST 10, 2021

________________________ Responsibility Center Code :

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

pc. Ballpen, HBW black 12 5.00 60.00

pc. Pencil, Mongol 1 6 4.00 24.00

bottle Glue, all-purpose 2 35.00 70.00

pc. Ruler, plastic 4 12.00 48.00

ream Bondpaper, Short 5 220.00 1,100.00

Purpose :
Various office supplies for staff use.

Requested by : Approved by :

Signature :

Printed Name : (Fill name of the Property custodian) NOEL I. BULAWAN

Designation : Property Custodian School Head

 Appendix 63

REQUISITION AND ISSUE SLIP

Entity Name : BARAS ELEMENTARY SCHOOL Fund Cluster : 01-MOOE

Division : _______________________________________________________ Responsibility Center Code : ____________________

Office : ________________________________________________________ RIS No. : _2021-08-000______________________
Requisition Stock Available? Issue
Stock No. Unit Description Quantity Yes No Quantity Remarks

- - -
√ 0 Out of stock

- - -
√ 0 Out of stock

- - -
√ 0 Out of stock

- - -
√ 0 Out of stock

- - -
√ 0 Out of stock

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

Purpose:
Various office supplies for staff use.

Requested by: Approved by: Issued by: Received by:

Signature :

Printed Name : (Fill in name of Resquestor) NOEL I. BULAWAN (Fill in name of supply officer) (Fill in name of Resquestor)

Designation : (Fill in position of requestor) School Head Supply Officer (Fill in position of requestor)

Date : 0 0 0
AO 6/15/02
 Republic of the Philippines
Department of Education
Region VIII (Eastern Visayas)
DIVISION OF LEYTE
CAPOOCAN II DISTRICT
Capoocan, Leyte

REQUEST FOR QUOTATION

RFQ :
DATE :

SIR/MADAM :

Please quote your lowest price for the following items enumerated below, taking into consideration the following
:
TERMS AND CONDITIONS
1. The Approved Budget for the Purchase is P ______________.
2. Price Quotation should be inclusive of the 5% VAT and Expanded Withholding Tax (EWT) of 1%.
3. Price Quotation should be valid within thirty (30) calendar days from the deadline of RFQ.
4. Delivery period is within fifteen (15) calendar days from receipt of Purchase Order.
5. If awarded the contract, processing and payment shall be made after the complete delivery of the
services/supplies and final acceptance.
6. Refusal to accept an award mayvbe ground for imposition of administrative sanctions under Rule XXII of the
revised RFQ of RA 9184.
7. FOB

8. The procuring entity may terminate the contract, in whole or in part at any time for unsatisfactory service.
QTY. UNIT DESCRIPTION UNIT PRICE TOTAL

Date : ________________________

I have read and understood the Terms & Conditions stated above.
By signing this quote, I hereby agree and bind myself to the Terms and Conditions.

___________________________
PBAC Chairman

Signature over printed Name : ___________________________

Position in Firm : _______________________________________
Business Address : _____________________________________
 Republic of the Philippines
Department of Education
Region VIII (Eastern Visayas)
Division of Leyte
Palo, Leyte

OFFICE OF THE SCHOOLS DIVISION SUPERINTENDENT

ABSTRACT OF CANVASS OF THE PRICES OPENED on ________________. Unless otherwise state all prices appearing below are unit price.
Quantity Unit Particulars Item No.
- - - 1
- - - 2
- - - 3
- - - 4
- - - 5
- - -
- - -
- - -
- - -
- - -
- - -
- - -

Place of Delivery : _____________________

Time of Delivery : ______________________

WE HEREBY CERTIFY that we actually witness the opening of the attached REQUEST FOR QUOTATIONS and that date shown are true and correct.

AGAPITA B. ALMERINO MERCY GRACE J. MARJADAS MARICEL B. BANDOQUILLO AGNES T. YEKYEK PURISIMA P. BELACSI
PBAC Chairman PBAC Member PBAC Member PBAC Member PBAC Member

APPROVED FOR PURCHASE under the facts here above stated from : _________________________________

AGAPITA B. ALMERINO NOEL I. BULAWAN

School Property Custodian School Head
 Appendix 61

PURCHASE ORDER

Entity Name

Supplier : P.O. No. :

Address : Date :

TIN : Mode of Procurement :

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 -
(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,

_________________________________
Signature over Printed Name of Supplier Signature over Printed Name of Authorized Official
_________________________________ School Head
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 : BARAS ELEMENTARY SCHOOL Fund Cluster : 01 - MOOE

Supplier : ASL Enterprises IAR No. : 2021-08-000

PO No./Date : Date : 15-Aug-19

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)

(FILL IN name of the Inspector) (FILL IN name of the property custodian)

Inspection Officer/Inspection Committee Supply and/or Property Custodian
 JOB ORDER

Entity Name

Supplier : J.O. No. :

Address : Date :

TIN : Mode of Procurement :

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 -
(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,

_________________________________
Signature over Printed Name of Supplier Signature over Printed Name of Authorized Official
_________________________________ School Head
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 59

INVENTORY CUSTODIAN SLIP

Entity Name: Potot Elementary School

Fund Cluster : _01 - MOOE ICS No :
Amount Inventory Estimated
Quantity Unit Description
Unit Cost Total Cost Item No. Useful Life
1 pcs 15,299.00 15,299.00 43 inch SHARP Google TV 2 yrs.

Received from: Received by:

AILYN D. DACALLOS MADELYN A. ALBINO

Signature Over Printed Name Signature Over Printed Name
Property Custodian T-I
Position/Office Position/Office
__________________________________ ______________________________
Date Date
Agency Name : Agency Name :
BARAS ELEMENTARY SCHOOL BARAS ELEMENTARY SCHOOL
CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS
Pursuant to COA Circular No. 2017-001 dated June 19, 2017 Pursuant to COA Circular No. 2017-001 dated June 19, 2017
Employee No. : Employee No. :
Office : DEPARTMENT OF EDUCATION Office : DEPARTMENT OF EDUCATION

Division : LEYTE DIVISION Division : LEYTE DIVISION

Particulars Amount (Ph) Particulars Amount (Ph)

Total Total
Purpose : Purpose :

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

Certified Correct : Noted by : Certified Correct : Noted by :

Signature Signature

Printed Name Printed Name

Payee/Employee Immediate Supervisor Payee/Employee Immediate Supervisor
Date Date
 Appendix 33

PAYROLL
For the period ______________________________________

Entity Name : BARAS ELEMENTARY SCHOOL Payroll No. : ______________

Fund Cluster : 01-MOOE Sheet __1__ of __1__ sheets

We acknowledge receipt of cash shown opposite our name as full compensation for services rendered for the period covered.

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

ALDRIN CAMERO LABORER 300/ DAY 1,500.00

(5 DAYS)

A CERTIFIED: Services duly rendered as stated. C

APPROVED FOR PAYMENT: ____________________________________________________________

__________________________________________________________ (P )

(FILL IN Name of the supply or inspector officer) 0 0

Supply Officer/Inspector Date (Signature over Printed Name) Date
Head of Agency/Authorized Representative

B CERTIFIED: Supporting documents complete and proper; and cash available in the amount of D CERTIFIED: Each employee whose name appears on the payroll has E
P______________________. been paid the amount as indicated opposite his/her name
ORS/BURS No. : __________
Date : ___________________
(FILL IN NAME OF DISBURSING) JEV No. : ________________
(Signature over Printed Name) Date (Signature over Printed Name) Date : ___________________
Head of Accounting Division/Unit Disbursing Officer
 Republic of the Philippines
Department of Education
Region VIII (Eastern Visayas)
DIVISION OF LEYTE
PALO DISTRICT III
Palo, Leyte

ACCOMPLISHMENT REPORT

DATE PROGRAM/PROJECT/ACTIVITY PERCENTAGE OF ACCOMPLISHMENT

Aug 1-31, 2021 clean the school premises 100% accomplished

mower the school ground

I HEREBY CERTIFY THAT ABOVE MENTION DETAILS OF THIS ACCOMPLISHMENT REPORT ARE TRUE AND CORRECT

Prepared by :

__________________________ Noted by :
School Property Inspector
________________________
School Head