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ANNEX C

SCHOOL LOGO
DEPARTMENT OF EDUCATION - REGION III CENTRAL LUZON
DIVISION OF CITY OF SAN FERNANDO
[NAME OF SCHOOL]
[ADDRESS OF SCHOOL]

Date

AR No: _______

FOR :

SCHOOL HEAD : [NAME OF SCHOOL HEAD]

FROM :

SCHOOL : [HEAD OF THE DEPARTMENT]

SUBJECT : Activity Request

NAME OF Program/Project Name:


PROGRAM(S)/
PROJECT(S)

OUTPUT(S) TO BE Output Code Output Physical Target


PRODUCED AND

ACTIVITY/IES TO Activity Code Name of Activity


BE REQUESTED

ACTIVITY/IES WITH
DOWNLOADING

ACTIVITY/IES TO Amount to be
BE BUMPED-OFF Activity Code Name of Activity
AND ITS CODE(S) bumped-off

Grand Total P_______________


FINANCIAL Activity Code Amount in WFP Amount Requested
REQUIREMENTS

Grand Total
SOURCE OF FUNDS

ADMINISTRATIVE Activity Inclusive


ARRANGEMENTS Sub-Activities Pax Remarks
Code Dates

ANNEXES 1. Activity Design/Program of Activities


2. List of Participants
3. Detailed Budget Estimates
4. Certification from Clearing House, if needed in the activity
5. Accomplished Purchase Request (PR), if any
6. Legal instrument or any form of directives from person in authority
7. Portion of the approved WFP where activities are stipulated.
All expenses incurred in this activity is subject to usual accounting and auditing rules
and regulations.

Prepared by:

[Name of Department Head]


[Department of the Proponent]

Approved by:

[Name of School Head]


School Head
ANNEX D

SCHOOL LOGO
DEPARTMENT OF EDUCATION - REGION III CENTRAL LUZON
DIVISION OF CITY OF SAN FERNANDO
[NAME OF SCHOOL]
[ADDRESS OF SCHOOL]

Date

ATC No: _______

FOR :

SDO: RONNIE S. MALLARI, Ph.D.

FROM :

SCHOOL : [NAME OF SCHOOL HEAD]

SUBJECT : Authority to Conduct

NAME OF Program/Project Name:


PROGRAM(S)/
PROJECT(S)

OUTPUT(S) TO BE Output Code Output Physical Target


PRODUCED AND
ITS CODE(S)

ACTIVITY/IES TO Activity Code Name of Activity


BE REQUESTED

ACTIVITY/IES WITH
DOWNLOADING

ACTIVITY/IES TO Amount to be
BE BUMPED-OFF Activity Code Name of Activity
AND ITS CODE(S) bumped-off

Grand Total P_______________


JUSTIFICATION
1. Not specified in
the WFP

2. Deviated from
the WFP

FINANCIAL Activity Code Amount in WFP Amount Requested


REQUIREMENTS

Grand Total
SOURCE OF FUNDS
ADMINISTRATIVE Activity Inclusive
ARRANGEMENTS Sub-Activities Pax Remarks
Code Dates

ANNEXES 1. Activity Design/Program of Activities


2 List of Participants
3. Detailed Budget Estimates
4. Certification from Clearing House, if needed in the activity
5. Accomplished Purchase Request (PR), if any
6. Legal instrument or any form of directives from person in authority
7. Portion of the approved WFP where activities are stipulated.

All expenses incurred in this activity is subject to usual accounting and auditing rules and
regulations.

Prepared by:

[Name of School Head]


School Head

Reviewed by: Allotment Available: Funds Available:

JANETTE F. AMORES MARIDOL M. AGAPITO DEXTER F. ABULENCIA


SEPS-SMME Administrative Officer V (Budget) Accountant III

Approved by:

RONNIE S. MALLARI, Ph.D.


OIC- Schools Division Superintendent

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