2015 by Remz FORMS Liquidation Report

Republic of the PhilippinesDEPARTMENT OF EDUCATION

Region 02DIVISION OF QUIRINO

Cabarroguis

LIST OF ATTACHMENTSLIQUIDATION REPORT OF SCHOOL MOOE

2 COPIES LIQUIDATION REPORT2 COPIES CASH DISBURSEMENT REGISTER2 COPIES LIQUIDATION REPORT SUMMARY

TRAVEL EXPENSES>> VOUCHER>> ITINERARY OF TRAVEL>> CERTIFICATE OF TRAVEL COMPLETED>> TRAVEL ADVICE/ AUTHORITY TO TRAVEL>> MEMO

>> BUS TICKET/ RER

TRAINING EXPENSES>> DISBURSEMENT VOUCHER>> OFFICIAL RECEIPT

PURCHASE OF SUPPLIES (ABOVE 1,000.00)>> DISBURSEMENT VOUCHER>> OFFICIAL RECEIPT

>> ABSTRACT OF SEALED QUOTATION (5 SIGNATURES)>> PURCHASE ORDER>> INSPECTION AND ACCEPTANCE REPORT

EMERGENCY PURCHASES (PURCHASES BELOW 1,000.00)>> DISBURSEMENT VOUCHER>> CERTIFICATE OF EMERGENCY PURCHASE>> OFFICIAL RECEIPT>> PURCHASE REQUEST>> PURCHASE ORDER>> ACCEPTANCE AND INSPECTION REPORT

WATER EXPENSES>> DISBURSEMENT VOUCHER>> OFFICIAL RECEIPT>> BILLING STATEMENT

ELECTRICITY EXPENSES>> DISBURSEMENT VOUCHER>> OFFICIAL RECEIPT>> BILLING STATEMENT

>> CERTIFICATE OF APPEARANCE (ORIGINAL COPY) OR CERTIFICATE OF PARTICIPATION (PHOTOCOPY)

>> PURCHASE REQUEST (be specific with the purpose of purchases)>> REQUEST FOR QUOTATION ( 3 SUPPLIERS) - with complete iteme specifications

>> PROPERTY ACKNOWLEDGEMENT RECEIPT ( NON-CONSUMABLES ONLY)

TELEPHONE EXPENSES>> DISBURSEMENT VOUCHER>> OFFICIAL RECEIPT>> BILLING STATEMENT

PURCHASE OF CONSTRUCTION MATERIALS>> DISBURSEMENT VOUCHER>> OFFICIAL RECEIPT>> PROGRAM OF WORK

>> REQUEST FOR QUOTATION ( 3 SUPPLIERS)>> ABSTRACT OF SEALED QUOTATION (5 SIGNATURES)>> PURCHASE ORDER>> INSPECTION AND ACCEPTANCE REPORT

REPAIR OF OFFICE AND IT EQUIPMENTS>> OFFICIAL RECEIPT>> JOB REQUEST>> PRE AND POST REPAIR INSPECTION>> CERTIFICATE OF EMERGENCY PURCHASE (IF THERE'S NO RFQ)

LABOR>> LABOR PAYROLL>> SUMMARY OF PAYROLL/S>> PICTURE OF THE PROJECT BEFORE, DURING AND AFTER>> PROGRAM OF WORK

SNACKS AND MEALS>> DISBURSEMENT VOUCHER>> OFFICIAL RECEIPT

>> REQUEST FOR QUOTATION ( 3 SUPPLIERS)>> ABSTRACT OF SEALED QUOTATION (5 SIGNATURES)>> PURCHASE ORDER>> INSPECTION AND ACCEPTANCE REPORT>> CONTRACT AGREEMENT WITH THE CATERER/ SUPPLIER>> ATTENDANCE SHEET OF PARTICIPANTS>> MEMO>> MENU >> TRAINING MATRIX (IF USED FOR SEMINARS/TRAININGS)

TRANSPORTATION AND DELIVERY EXPENSES (IF HIRED VEHICLE)>> OFFICIAL RECEIPT/ RER>> CONTRACT AGREEMENT WITH THE DRIVER>> LIST OF PASSENGERS

***remz/acctg/2015***

>> PURCHASE REQUEST (be specific with the purpose of purchases)

>> PROPERTY ACKNOWLEDGEMENT RECEIPT ( NON-CONSUMABLES ONLY)

>> PURCHASE REQUEST (be specific with the purpose of purchases)

- with complete iteme specifications

CASH DISBURSEMENTS REGISTER

Agency: Name of Accountable Officer: Sub-Office/District/Division: Official Designation : Municipality/City/Province: Station :

Date PARTICULARS

Cash - Disbursing Officers BREAKDOWN OF PAYMENTSTravelingTraining Office OTHERS AMOUNT

Amount ExpensesExpensesSuppliesDEBIT CREDITCash

Payments BalanceExpenses

Advance 502010105020201050203010BEGINNING BALANCECASH ADVANCE -

- - - - - - - - - - - -

TOTALS - - - - - - - -

Certified Correct: CERTIFIED: NOTED:SUPPORTING DOCUMENT COMPLETE

JOJO L. NOVILLERO BENJAMIN D. PARAGAS, Ph. D., CESO VName of School Head Accountant III SCHOOL DIVISION SUPERINTENDENT

(Date) (DATE) (Date)

DV. No./ Payroll/

Check No. Account Description

Account Code

LIQUIDATION REPORT No : 2015 - ____ - ______Date:

DepEd - Division of Quirino Responsibility Center:Agency

Code:

PARTICULARS AMOUNT

To liquidation of Cash Advance for the month of September, 2015 in the amount of …………………………………… 20,000.00

TOTAL AMOUNT SPENT 20,000.00 AMOUNT OF CASH ADVANCE PER DV. NO. 20,000.00 BALANCE -

A. Certified: Correctness of the above B. Certified: Purpose of trave/cash C. Certified : Supporting documents

above data advance duly accomplished complete

BENJAMIN D. PARAGAS, Ph.D.,CESO V JOJO L. NOVILLEROSchools Division Superintendent Accountant III

Claimant Immediate Supervisor Head, Accounting Unit

JEV. No.

Republic of the Philippines

DEPARTMENT OF EDUCATIONRegion 02

Division of Quirino

Cabarroguis, Quirino

DISBURSEMENT VOUCHER

MODE OF PAYMENT No.

X MDS Check Commercial Check A D A Others Date: June 17, 2014

Payee/ Office: TIN / Employee No.: OS/BUS No.

Date: June 17, 2014

Address: Responsibility Center :Title: Code:

PARTICULARS AMOUNT

Amount Due B P

A Certified: Supporting documents complete B Approved for Payment:

X Cash Available

Subject to ADA (where applicable)

Signature : Signature :

Printed Name: JUDITH R. CAMBI Printed Name: BENJAMIN D. PARAGAS, Ph.D., CESO V

Position : ADAS III/OIC-Accountant Position : Schools Division Superintendent

(Head, Accounting Unit/Authorized Representative)

Date : Date :

C Received Payment: D

Check/ADA No.: J.E.V. No.:

Signature : Date : ____________ Date:

Bank Name:

Printed Name: OR No./ Other relevant document Date:

Issued :

DISBURSEMENT VOUCHER

Responsibility Center :

AMOUNT

BENJAMIN D. PARAGAS, Ph.D., CESO V

Schools Division Superintendent



Cabarroguis

JOB REQUEST

Sir/Madam:

Approval for undertaking job/activities indicated below is hereby requested:

JOB DESCRIPTION PURPOSE

I hereby certify that the contracts of labor services in undertaking the above activitiesare necessary and will be used for the purpose stated above.

Requesting Official: Funds Available:

Approved by:

I hereby certify that the contracts of labor services in undertaking the above activities

PURCHASE REQUEST

DEPARTMENT OF EDUCATION(Agency)

Department : PR No.: ___________ Date:Section : SAI No.: ___________ Date:

STOCKUNIT DESCRIPTION QUANTITY

UNITAMOUNT

NO. COST

Purpose:

Requested by: Approved by:

SIGNATURE:PRINTED NAME:DESIGNATION:

`



Cabarroguis

BIDS AND AWARDS COMMITTEE

Request for Quotation

Date: _________________ Quotation No.: _________________

To all Eligible Suppliers:

I. Please quote your lowest price inclusive of VAT on the item/s listed below, subject to the Terms and Conditions of this R F Q, and submit your quotation duly signed by your respresentative not later

please call ___________________________________________ at CP Nos: Prospective supplier shall be responsible to verify the quoted items from above - stated School and Telephone No./s.

BAC Chairperson

ITEMS & DESCRIPTION QTY UNIT PRICE

Supplier's Company Name: TIN No.:

Address:

Telephone No.: Fax No.: E - mail:

Date:

than _____________________ at ____________________________________ . For more information

Item No.

Packaging / Unit

Statement of Compliance

(State "Comply" or

"Not Comply")

This is to submit our price quotation as indicated above subject to the terms and conditions of this RFQ.

Supplier's Authorized Representative Siganature

over Printed Name:

Please quote your lowest price inclusive of VAT on the item/s listed below, subject to the Terms and Conditions of this R F Q, and submit your quotation duly signed by your respresentative not later

please call ___________________________________________ at CP Nos: Prospective supplier shall be responsible to verify the quoted items from above - stated School and Telephone No./s.

accomplished by supplier.

such document within three (3) calendar days from receipt by the bidder of notice shall be ground for

disqualification.

The supplier who submitted the lowest calculated responsive quotation shall be a

evaluation by the BAC.

vegetables, fish, poultry, meat products and other perishables, delivery shall be made on stag

and mode of delivery (e.g. weekly, every two weeks, etc.) depending on storage capacity of the school

cost to the account of supplier. Risk and title shall pass from the supplier to

acceptance of the Goods and Project Site.

documents to the Purchaser:

For the purpose of these conditions, Purchaser's representative at the Project Site is the

_______________________________________________.

Quotation shall be compared and evaluated on the basis of the following criteria:

the schedule, and specifications of the award or purchase order. Failure of the supplier to

be ground for cancellation of the award or purchase order issued to the supplier.

effect. A telephone call or fax transmission shall constitute an official notice to the Supplier. Th

remains unclaimed, the purchase order shall be cancelled. To avoid delay in the

requirements, all defaulting suppliers shall be precluded from proposing or submitting substit

shall be disqualified from participating DepEd or any DepEd units’ future procurement activities. This is without prejudice to the

imposition of other sanctions prescriber under R.A. 9184 and it’s IRR – A against the supplier.

delayed deliveries.

equipment purchased shall be submitted by the supplier to the Department of Education.

regulation(s) of the Bureau of Internal Revenue.

The supplier shall provide such packing of the Goods appropriate to prevent

Project Site. Goods shall be packed in appropriate containers with label identifying the content and quantity per package with

the name of the Purchaser and marked “Not for Sale – Government Property”.

Inner packaging of grocery items must have Food – Grade Plastics Lining, label to include the

Manufacturing date, 3) Expiry date, 4) Name of Manufacturer, 5) Address(where manufactured), 6) License to operate number,

if applicable.

costs of the necessary laboratory test undertaken by DepEd on the Goods shall be to the account of suppliers.

A penalty of one – tenth of one percent (0.001) of the total value of the undelivered Goods shall be charge

every day of delay of the delivery of the purchased Goods.

Warranty shall be for period of six (6) months for supplies and materials, and one year in case of

acceptance of the Goods at Project site.

II. Terms and Conditions

A. Submission of Requirements

1. Sealed quotations and requirements stated below shall be submitted to the Bids and Awards (BAC) _____________________.

2. Suppliers shall submit the following requirements:

i. Duly signed Request for Quotation. Prices shall be quoted in Philippine Peso. Statement of Compliance must be

3. For submission prior to Award

a. 1) Valid Mayor's Permit, 2) Tax Clearance Certificate, & 3) PhilGEPS Registration Certificate. Bidder's failure to submit

B. Award

C. Delivery

1. Delivery of Goods shall be made within seven (7) calendar days from date of receipt of Purchase Order. To ensure the quality of

2. Deliverable shall be delivered to the ___________________________________________ hereto defined as Project Site,

3. Upon delivery of Goods to the Project Site, the supplier shall notify the Purchaser and present the following

i. Original and 4 copies of the Supplier's Invoice showing the Goods description, quantity, unit price and total price.

ii. Original and 4 copies of Delivery Receipts

iii. Original Statement of Accounts

iv. Approved Purchaser Order

v. Warranty Certificate, if applicable.

D. Evaluation of Quotation

1. Completeness of Submission

2. Compliance with Technical Specifications

3. Price

E. Instructions

1. Supplier shall be responsible for the source(s) of its Goods/equipment, and shall make the deliveries in accordance with

2. Supplier shall pick - up the purchase order issued in its favor within three (3) calendar days from date receipt of notice to that

3. Supplier who accepted a purchase order but failed to deliver the required Goods within the time called for in the purchase order

4. Rejected deliverers shall be construed as non – delivery, and shall be replaced by the supplier subject to liquidated damages for

5. All duties, exercise and other taxes and revenue charge be paid the supplier.

6. As a pre – condition to payment, Importation Documents specifically showing the conditions and serial numbers of the imported

7. All transactions are subject to withholding of credible Value Added Tax and/or Expanded Value Added Tax per revenue

F. Packing

G. Inspection

1. All deliveries by supplier shall be subject to inspection, and acceptance by the DepEd Inspection Team and the end – user. All

2. For the purpose of this condition, Purchaser’s representative at Project Site is ___________________________________.

H. Liquidated Damages

I. Warranty

One hundred percent (100%) of the Contract Price shall be paid to the supplier after acceptance of the Goods at

of the documents provide under C. Delivery.

After having carefully read and accepted your Request for Quotation and its Terms and Condition, I/We quote

noted in the RFQ. The quotation shall be binding upon us for thirty (30) calendar days reckoned from last day of submission indicated in

the Submission Requirements. The corresponding Award on Purchase Order shall be accepted by us at any time before expiration of this

period.

J. Payment

(back page of RFQ 1)

such document within three (3) calendar days from receipt by the bidder of notice shall be ground for

The supplier who submitted the lowest calculated responsive quotation shall be a

evaluation by the BAC.

vegetables, fish, poultry, meat products and other perishables, delivery shall be made on stag

and mode of delivery (e.g. weekly, every two weeks, etc.) depending on storage capacity of the school

cost to the account of supplier. Risk and title shall pass from the supplier to

acceptance of the Goods and Project Site.

documents to the Purchaser:

For the purpose of these conditions, Purchaser's representative at the Project Site is the

Quotation shall be compared and evaluated on the basis of the following criteria:

the schedule, and specifications of the award or purchase order. Failure of the supplier to

be ground for cancellation of the award or purchase order issued to the supplier.

effect. A telephone call or fax transmission shall constitute an official notice to the Supplier. Th

remains unclaimed, the purchase order shall be cancelled. To avoid delay in the

requirements, all defaulting suppliers shall be precluded from proposing or submitting substit

shall be disqualified from participating DepEd or any DepEd units’ future procurement activities. This is without prejudice to the

imposition of other sanctions prescriber under R.A. 9184 and it’s IRR – A against the supplier.

equipment purchased shall be submitted by the supplier to the Department of Education.

The supplier shall provide such packing of the Goods appropriate to prevent

Project Site. Goods shall be packed in appropriate containers with label identifying the content and quantity per package with

the name of the Purchaser and marked “Not for Sale – Government Property”.

Inner packaging of grocery items must have Food – Grade Plastics Lining, label to include the

Manufacturing date, 3) Expiry date, 4) Name of Manufacturer, 5) Address(where manufactured), 6) License to operate number,

costs of the necessary laboratory test undertaken by DepEd on the Goods shall be to the account of suppliers.

A penalty of one – tenth of one percent (0.001) of the total value of the undelivered Goods shall be charge

Warranty shall be for period of six (6) months for supplies and materials, and one year in case of

Sealed quotations and requirements stated below shall be submitted to the Bids and Awards (BAC) _____________________.

Duly signed Request for Quotation. Prices shall be quoted in Philippine Peso. Statement of Compliance must be

1) Valid Mayor's Permit, 2) Tax Clearance Certificate, & 3) PhilGEPS Registration Certificate. Bidder's failure to submit

Delivery of Goods shall be made within seven (7) calendar days from date of receipt of Purchase Order. To ensure the quality of

Deliverable shall be delivered to the ___________________________________________ hereto defined as Project Site,

Upon delivery of Goods to the Project Site, the supplier shall notify the Purchaser and present the following

Original and 4 copies of the Supplier's Invoice showing the Goods description, quantity, unit price and total price.

Supplier shall be responsible for the source(s) of its Goods/equipment, and shall make the deliveries in accordance with

Supplier shall pick - up the purchase order issued in its favor within three (3) calendar days from date receipt of notice to that

Supplier who accepted a purchase order but failed to deliver the required Goods within the time called for in the purchase order

Rejected deliverers shall be construed as non – delivery, and shall be replaced by the supplier subject to liquidated damages for

All duties, exercise and other taxes and revenue charge be paid the supplier.

As a pre – condition to payment, Importation Documents specifically showing the conditions and serial numbers of the imported

All transactions are subject to withholding of credible Value Added Tax and/or Expanded Value Added Tax per revenue

All deliveries by supplier shall be subject to inspection, and acceptance by the DepEd Inspection Team and the end – user. All

For the purpose of this condition, Purchaser’s representative at Project Site is ___________________________________.

One hundred percent (100%) of the Contract Price shall be paid to the supplier after acceptance of the Goods at

After having carefully read and accepted your Request for Quotation and its Terms and Condition, I/We quote

noted in the RFQ. The quotation shall be binding upon us for thirty (30) calendar days reckoned from last day of submission indicated in

the Submission Requirements. The corresponding Award on Purchase Order shall be accepted by us at any time before expiration of this



Cabarroguis(SCHOOL)

Date:ABSTRACT OF SEALED QUOTATION

ITEM QNTY./ ARTICLES TO BE PURCHASED NO. UNIT OR WORK TO BE DONE

RECOMMENDING AWARD TO:

CERTIFIED CORRECT BASED ON CANVASS MADE:

-AWARD-After each careful deliberation of the above abstract, this office had decided to accept and awards the same to ____________

whose prices offered maybe considered reasonable and advantageous to the best interest of the government.

BAC Member BAC Member BAC Member

BAC Vice Chairman BAC Chairman

PURCHASE ORDERDEPARTMENT OF EDUCATION

(Agency)

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 of Term:


UNITAMOUNT

NO. COST

Conformed:

Authorized OfficialSignature Over Printed Name of Supplier

Date

Funds Available:ALOBS No.

School Treasurer/DesignationAMOUNT:

INSPECTION AND ACCEPTANCE REPORT

DEPARTMENT OF EDUCATION(Agency)

Supplier: IAR No.P.O No. Date:Requesting Office/Dep.:


NO.

INSPECTION ACCEPTANCEDate Inspected: Date Accepted: [ X ] Inspected, verified and found in order as to [ X ] Complete quantity and specifications.

[ ] Partial (pls. Specify quantity)

Inspection Officer/Inspection Committee

Property OfficerMember

Member

Date: Invoice No.:

DEPARTMENT OF EDUCATION DIVISION OF QUIRINO

PROPERTY ACKNOWLEDGMENT RECEIPT

School:District:

Quantity Unit DescriptionUnit Property Date

CostPrice No. Acquired

P P

Received by: Issued by:

Signature Over Printed Name Signature Over Printed NameRecipient/User

Property Custodian/ (Designation)Position Position

______________ ______________Date Date


Region 02

DIVISION OF QUIRINOCabarroguis, Quirino

NO.:

ITINERARY OF TRAVEL

NAME:

PURPOSE OF TRAVEL:

DATEPLACE TO BE TIME MEANS OF

TRANS. PER-DIEM DAILY

VISITED DEPARTURE ARRIVAL TRAVEL Allow.

Prepared by: I CERTIFY that (1) I have reviewed the foregoing

Itinerary; (2) the travel is necessary to the service;

(3) the period covered is reasonable; and (4) the

expenses claimed are proper.

Approved:

Immediate Supervisor



Region 02

DIVISION OF QUIRINOCabarroguis, Quirino

ITINERARY OF TRAVEL

TOTALAMOUNT




Appendix B

CERTIFICATE OF TRAVEL COMPLETED

(Agency Head) (Station)

(Position) (Date)

I certify that I have completed the travel authorized in the Itenerary of Travel No.__________________ dated

_________________under condition indicated below:

X Strictly in accordance with approved itinerary.

O.R. No. _________________ dated ___________________.

Extended as explained below, additional itinerary was submitted.

Other deviations as explained below.

Explanation or Justification:

Evidences of travel attached hereto:

Submitted By:

(Employee)

On evidence and information of which I have knowledge, the travel was actually undertaken.


Cut short as explained below, excess payment in the amount of P 00.00 was refunded under



Appendix B

CERTIFICATE OF TRAVEL COMPLETED

(Station)

(Date)

I certify that I have completed the travel authorized in the Itenerary of Travel No.__________________ dated

On evidence and information of which I have knowledge, the travel was actually undertaken.

Appendix 18



PRE-REPAIR INSPECTION REPORT

Item/Description:

Property Number: Property Accountability Receipt

Acquisition Cost: Acquisition Date:

Nature and Scope of Last Repair, if any:

Complaints/Defects:

Parts/Componets to be Repaired/Replaced:

FINDINGS/OBSERVATIONS:

Property Inspector/Date

POST-REPAIR INSPECTION REPORT

Job Order No. Amount: Invoice No. Amount:

FINDINGS/COMMENTS:

Property Inspector/Date

Appendix 18

Appendix 37

SUMMARY OF PAYROLLS

Revised January 1992______________________________________

(Project)

Agency Period:

Amounts Amount Amount UnpaidPayroll number of Rolls Paid On Rolls On Rolls

1. Labor Payroll

TOTALPrepared by: Certified Correct:

Principal IIACCOUNTING ENTRY

Account Code Debit Credit Certified Correct:

(Revised August 1940) Sheet No. . . . . . . . TIME BOOK AND PAYROLL

For payment of labor for the _____________________________________________________________NO. RATE AMOUNT LESS NET RESIDENT

SIGNATUREOF DAYS PER DAY/ PAID VAT AMOUNT CERTIFICATE

TIME PAYROLL WORKED MONTH 2% NUMBER(P) (P) (P) (P) DATE PLACE

(Mark time each day under proper date using fraction when necessary)

No. NAME Position1 2 3 4 5 6 7 8 9 10 11 12 13 14 1516 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1

2

3

4

Total -

1. I HE3REBY CERTIFY that each person whose name appears on 2. I CERTIFY that this roll is correct, every person whose appears hereon rendered service 3. I CERTIFY on my official that I have this ______________

this payroll rendered service as indicated and for the time stated. for the time and at the rates stated, under my general supervision and I approve this roll. day of ______, 19______ paid in cash to each man whose

name appears on the above roll, the amount set

CHECKED BY: APPROVED: opposite his name, he having presented himself,

established his identity; and affixed his signature or

Property Custodian thumbmark on the space provided thereof. Unpaid

services are indicated by red ink through the column

School Treasurer School Principal "Amount Paid".

Note: Where thumb marks is to be used in place of signature and the space available not sufficient the thumb mark may be impressed on the back hereof with proper Special Disbursing Officer, Paymaster, or

indication of the corresponding laborer's number and on the corresponding line on payroll remark "see thumbmark on the back" should be written. School Treasurer _____________



CERTIFICATE OF EMERGENCY PURCHASE

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that within purchase covered by the following invoice/s, to with:

Date Sale Invoice/Cash Invoice/OR No. Amount

is urgent in nature and/or indispensable to prevent serious impairment of public service and there was no material time to secure them thru price quotatation of atleast three (3) reputable dealers in the locality at the time of purchase, that the prices for the supplies and materials/services are just, reasonable and advantageous to the government.

Employee

CERTIFICATE OF ACCEPTANCE

THIS IS TO CERTIFY that after the inspection of emergency purchase covered by the above stated sales invoice/cash invoice/official receipt, IT WAS FOUND AND VERIFIED THAT THE DELIVERY HAS BEEN accomplished in accordance with the terms and conditions of the purchase request and therefore is hereby accepted.


Issued this 24th day of October, 2014 at DepED-DO Quirino.

THIS IS TO CERTIFY that within purchase covered by the following invoice/s, to with:

is urgent in nature and/or indispensable to prevent serious impairment of public service and there was no material time to secure them thru price quotatation of atleast three (3) reputable dealers in the locality at the time of purchase, that the prices for the supplies and materials/

THIS IS TO CERTIFY that after the inspection of emergency purchase covered by the above stated sales invoice/cash invoice/official receipt, IT WAS FOUND AND VERIFIED THAT THE DELIVERY HAS BEEN accomplished in accordance with the terms and conditions of the purchase



Cabarroguis

SUMMARY OF EMERGENCY PURCHASES

DATE AMOUNT PURPOSE

Prepared by:

Acting Bookkeeper

Certified:

School Head

OR #

General Form No. 2 General Form No. 2Revised January 1992 Revised January 1992

REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPTDate No. Date No.

RECEIVED from RECEIVED from (Name) (Name)

the amount the amount(Official Designation) (Official Designation)

of ( P ) of ( P )(In Words) (In Figures) (In Words) (In Figures)

in payment for in payment for (Payments for subsistence, services, (Payments for subsistence, services,

rental or transportation should show inclusive dates rental or transportation should show inclusive dates

purpose, distance, inclusive points of travel, etc.) purpose, distance, inclusive points of travel, etc.)

PAYEE PAYEE

Name/Signature Name/Signature

Address Address

Comm. Tax Cert. No. Comm. Tax Cert. No.

Date of Issue Date of Issue

Place of Issue Place of Issue

WITNESS WITNESS

Name / Signature Name / Signature

Address Address

Comm. Tax Cert. No. Comm. Tax Cert. No.

Date of Issue Date of Issue

Place of Issue Place of Issue

INSTRUCTIONS INSTRUCTIONS

REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPT

1. Reimbursement Expense Receipt for payments of more than 1. Reimbursement Expense Receipt for payments of more than P35.00 should be secured. P35.00 should be secured.

2. The address of the payee, his Community Tax Certificate 2. The address of the payee, his Community Tax Certificate Number, the date and place of issue should be indicated below Number, the date and place of issue should be indicated below his name and signature. If his Community Tax Certificate is not his name and signature. If his Community Tax Certificate is not available, the payment should be witnessed by one who has.The available, the payment should be witnessed by one who has.The number, date and place of issue of the Community Tax Certificate number, date and place of issue of the Community Tax Certificate

3. A witness is likewise required in cases when the signature of the 3. A witness is likewise required in cases when the signature of the payee is illegible, or when he cannot sign, and acknowledgment payee is illegible, or when he cannot sign, and acknowledgment is made by a thumbmark. is made by a thumbmark.