Waste Material Report

ANNEX A
Revised Guidelines and Documentary Requirements for the Liquidation of School MOOE
No. of
ELEMENTARY SECONDARY
Copies
CASH ADVANCE REQUEST

1 Obligation Request and Status (ObR) 4 School Head /Budget Officer School Head /Budget Officer
2 Disbursement Voucher (DV) 6 School Head /Division Accountant/ SDS School Head /Division Accountant/ SDS
3 Request Letter 0 School Head School Head
4 EDILBERTO B. PANGAN 1 August 17,2018
LIQUIDATION
JANITORIAL FEE 4,000.00
1 Cash Disbursement Register 4 School Head /Bookkeeper School Head / Bookkeeper
2 Summary of Expenses 4 School Head School Head
3 Approved Disbursement Voucher 1
ELECTRIC
1 Cash Disbursement Voucher 1 School Head/Payee School Head/Payee
2 Aug-18 1
Billing Statement(Original only) attached photocopy

3 1
if the Billing Statement is printed on thermal paper
4 Certification from PTA (Indicate the period) 1 School Head/PTA President School Head/PTA President
5 BIR Form 2306 & 2307 1 EDILBERTO B. PANGAN
WATER
2 Official Receipt (Original & Xerox) 1
3 Billing Statement(Original & Xerox) 1
4 Certification from PTA (Indicate the period) 1 School Head/PTA President School Head/PTA President
5 BIR Form 2306 (except for Tax Exempt) 1
INTERNET AND TELEPHONE

2 Official Receipt 1
3 Billing Statement 1
Certification that calls are for Official Business (in
4 1 School Head School Head
case there is long distance calls)
5 Certification from PTA 1 School Head/PTA President School Head/PTA President
6 EDILBETO B. PANGAN 1 August 17,2018
*ES, SS and SHS can may subscribe to internet connectivity services of upto 4,000.00 per month for their faculty and computer lab used but
subject to availabilty, sufficiency and will not not detriment the ES, SS, and SHS MOOE funds. (DO 46, s. 2011)
JANITO**All new internet line application shall be supported with justification prepared by the School Head noted by the Division IT Coordinator (In case
of Computer Lab Internet Connection only), Division Accountant and ASDS.
TELEPHONE - Mobile (MAX. P300.00 ONLY)

2 Official Receipt (Original) 1
3 Billing Statement (Original) Or Prepaid Card 1
Aug-18
TRAVEL (ELEM - MAX. P1,000.00
TRAVEL SECONDARY (JHS and SHS)- MAX P2,000.00 WITH APPROVAL OF SDS) Maximum of 6 travel per month
Cash Disbursement Voucher 1 EDILBERTO B. PANGAN School Head/Payee
2 Itinerary of Travel (Appendix A) 1 School Head /PSDS School Head/ SDS
Signed by the person being transacted Signed by the person being transacted
3 Certificate of Appearance/ Personnel Locator Slip 1
with with
4 Acknowledgement Receipt - in case of rented jeeps and tricycle for purchases to DBM
*The School Heads may separate transportation cost related to purchase of office supplies to DBM, subject to reasonableness of the cost and if
the items purchased is not practicable to hand carry.
SEMINAR/TRAINING (REGISTRATION)
2 Travel Order 1 School Div. Supt. School Div. Supt.
3 Deped Order/ Memoranda, Invitation 1
4 Itinerary of Travel (Appendix A) 1 School Head /PSDS School Head/ SDS
5 Certificate of Travel Completed (Appnendix B) 1 School Head /PSDS School Head/ SDS
Official Reciept (Registration Fee, Bus Ticket,
6 1
Airfare)
Original Copy of plane/boat/bus tickets, boarding
7 1
pass, terminal fee receipt
8 Certificate of Appearance(Original) 1
9 Certificate of Participation (Photocopy) 1
Page 1 of 42
PURCHASES - DBM
2 Agency Procurement Request 1 BAC/ School Head BAC/ School Head
3 Price Quoataion and Stock Availability Cert. 1
5 Delivery receipt 1
Inspection And Acceptance Report (With attached
Inspected by: Inspectorate team Inspected by: Inspectorate team
6 photo of the actual items with the BAC and 2
Accepted by: Property Custodian Accepted by: Property Custodian
Property Custodian in the school vicinity)
Requisition and Issue Slip for Office supplies and Issued by: Property Custodian Issued by: Property Custodian
7 1
Other Materials (RIS) Received by: School Head Received by: School Head
Inventory Custodian Slip (ICS), for issuance of Issued by: Property Custodian Issued by: Property Custodian
8 2
semi-expendables Received by: Recipient Received by: Recipient
PURCHASES - SHOPPING MODE

2 Certificate of Non-availability of Stocks from DBM P 1
3 Philgeps Posting for P50,000.00 and above 1
4 Purchase Request 1 BAC/ School Head BAC/ School Head
5 Quotation Price( at least 3 store/supplier ) 1 BAC/Supplier BAC/Supplier
6 Abstract 1 BAC Members/School Head BAC Members/School Head
7 Purchase Order 1 School Head/Supplier School Head/Supplier
Sales Invoice and Official Receipt/
8 1
Acknowledgement Receipt (AR)*
9 photo of the actual items with the BAC and 2
Property Acknowledged Receipt (PAR), for Issued by: Property Custodian Issued by: Property Custodian
10 1
issuance of property and equipment (PPE) Received by: Recipient Received by: Recipient
Requisition and Issue Slip for Office supplies and Issued by: Property Custodian Issued by: Property Custodian
11 1
Other Materials (RIS) Received by: School Head Received by: School Head
Inventory Custodian Slip (ICS), for issuance of Issued by: Property Custodian Issued by: Property Custodian
12 2
semi-expendables Received by: Recipient Received by: Recipient
13 BIR Form 2306 & 2307 1
Purchases of Semi-Expendable – Office Equipment, Furniture and Fixtures and ICT Equipment (Below 15,000.00) should have justification
prepared by the School Head and noted by ASDS.
REPAIRS AND MAINTENANCE

IA Teacher, School Head, DepEd Engr. IA Teacher, School Head, DepEd Engr.
2 Program of Works 1
And SDS and SDS
3 Purchase Request BAC/ School Head BAC/ School Head
6 Purchase Order/Job Order 1 School Head/Supplier School Head/Supplier
7 Sales Invoice and Official Receipt 1
Certificate of Post-Repair Inspection and Inspected by: Inspectorate team Inspected by: Inspectorate team
8 1
Acceptance Accepted by: Property Custodian Accepted by: Property Custodian
Certifed correct: Property Custodian Certifed correct: Property Custodian
9 Waste Material Report 1
Approved by: School Head Approved by: School Head
10 Pictures - Before, During and After 1
11 Form 1 1
12 BIR Form 2306 & 2307 1
SECURITY AND JANITORIAL SERVICES

2 Job Order Contract 1
3 Daily Time Record 1
4 Daily Accomplishment Report 1
5 PTA Certification 1 School Head/PTA President School Head/PTA President
6 Payroll 1 School Head/District Supervisor School Head / Asst. School Div. Supt.
TEST PAPER
1 Justification 1 School Head / PSDS School Head / PSDS
5 Purchase Order/Job Order 1 School Head/Supplier School Head/Supplier
6 Breakdown of Photocopies 1 School Head School Head
7 PTA Certification 1 School Head/PTA President School Head/PTA President
Distribution List to Teachers (Testpapers received
9 1
by each Teacher - signed)
10 Printed actual Teastpapers (1 copy each subject) 1
11 BIR Form 2306 & 2307 1
TARPAULIN PRINTING
1 Purchase Request (PR) 1 BAC/ School Head BAC/ School Head
2 Price Quotations (at least 3 companies) 1 BAC/Supplier BAC/Supplier
4 Purchase Order (PO)/ Job Order (JO) 1 School Head/Supplier School Head/Supplier
Page 2 of 42
Page 3 of 42
6 Picture of Tarpaulin posted on designated area 1
7 Division Memo 1
8 2306 and 2307 1
DOCUMENTARY STAMPS
2 Acknowledgement Receipt 1
3 List of Graduates 1
4 List of Serial Numbers 1
5 Photocopy of Documentary Stamps 1
GAD TRAINING
1 Approved GAD Program 1 Chief SGOD/ SDS Chief SGOD/ SDS
2 Philgeps Posting for P50,000.00 and above
7 Sales Invoice and Official Receipt/ Acknowledgemen 1
8 GAD Report 1 School Head School Head
9 Attendance Sheet (Original) 1
10 BIR Form 2306 & 2307 1
Outsourcing Venue and Accommodation to 3rd Party is no longer allowed , should be direct to Supplier
ID (P50.00 per student)

1 Philgeps Posting for P50,000.00 and above
2 Number of Enrollees 1 School Head School Head
Sales Invoice and Official Receipt/
7 1
Acknowledgement Receipt (AR)*

8 photo of the actual items with the Inspectorate and 1
Issued by: Property Custodian Issued by: Property Custodian

9 Requisition and Issue Slip for Office supplies and Ot 1
Received by: School Head Received by: School Head
10 BIR Form 2306 & 2307 1
Use of Reimbursement Expense Receipt (RER) is no longer acceptable, instead Acknowledgement Receipt (AR) shall be used as supporting
Note:
documents subject to provision of COA Circular 2006-06.
Use of Acknowledgement Receipt (AR)
As per COA Circular 2004-06 dated September 9, 2004, the AR shall be acceptable for disbursments made from the cash advance of the disursing officer where
the payee is not a business entity required by the Bureau of Internal Revenue to issue ORs. It may be printed, typewritten and must bear the signature of the
payee.
Transactions where AR can be used:

1. Rental of van/jeep/tricycle for transportation use.
2. Wages of hired carpenters, plumbers and the likes.
* 3. Rentals of chairs and sound system (for used in graduation rites) from private individuals subject to the following condition;
there should be a service agreement/contract, has photocopy of atleast one valid ID of the entity contracted, the school is located
on a very rural area and the price is reasonable/ within industry standard.
Note: 1. Only schools tagged with hardship posts shall be contrued as schools located on a very rural area.
Page 4 of 42
Republic of the Philippines
Department of Education
SCHOOLS DIVISION OFFICE OF PAMPANGA
High School Blvd., Brgy. Lourdes, City of San Fernando (P)
OBLIGATION REQUEST AND STATUS
Payee/Office: MARDY B. SALCEDO No:

Date:
SAN JUAN ELEMENTARY SCHOOL Fund:
Responsibility
Particulars MFO/PAP UACS Code/ Expenditure Amount
Center
To obligate payment of : 32,300.00

MOOE Cash Advance
Period Covered : JANUARY 2019
SCHOOL: SAN JUAN ES

DISTRICT: SAN SIMON TOTAL
SCHOOL ID: 159503 32,300.00
A. Certified: Charges to appropriation/allotment necessary, B. Certified: Allotment available and obligated for the
lawful and under my direct supervision, and supporting purpose/adjustment necessary as indicated above.
documents valid, proper and legal.
MARDY B. SALCEDO REMEDIOS M. BACANI

TIC Admin. Officer V
C. STATUS OF OBLIGATION
Reference Amount
Date Particulars ORS/JEV/RCI/RADAI No. Obligation Payment Not Yet Due Due and Demandable
CASH ADVANCE 32,300.00 32,300.00
Sep-18
Totals
Republic of the Philippines Document Code:
SDOPAMP-QF-OSDS-ACC-019
Revision: 00
Region III
Effectivity. date: 05-08-2018
Name of Office:
High School Blvd., Brgy. Lourdes, City of San Fernando ACCOUNTING
SAN SIMON DISTRICT

SAN AGUSTIN ELEMENTARY SCHOOL
CASH DISBURSEMENT VOUCHER
DV No.:
Payee: BUREAU OF INTERNAL REVENUE Date: MARCH ,2020
Particulars Amount
56-DOCUMENTARY STAMPS 1,680.00
OR Number:
SI Number:
Period Covered:
Approved for Payment: Payment Received by:
______________________________
PORCIA P.SANTIAGO/ESHT-I

SDOPAMP-QF-OSDS-ACC-019
Revision: 00
Region III
Effectivity. date: 05-08-2018
Name of Office:
High School Blvd., Brgy. Lourdes, City of San Fernando ACCOUNTING
SAN SIMON DISTRICT

CASH DISBURSEMENT VOUCHER

DV No.:
Payee: BUREAU OF INTERNAL REVENUE Date: MARCH , 2020
Particulars Amount
56 DOCUMENTARY STAMPS 1,680.00
OR Number:
SI Number:
Period Covered:
Approved for Payment: Payment Received by:
______________________________
PORCIA P. SANTIAGO /ESHT-I
REPUBLIC OF THE PHILIPPINES Fund Cluster :
DEPARTMENT OF EDUCATION
High School Blvd., Brgy. Lourdes, City of San Fernando (P)
Date :
DISBURSEMENT VOUCHER DV No. :
Mode of MDS Check Commercial Check ADA Others (Please specify)

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee MARDY B. SALCEDO
272-001-679
Address SAN JUAN,SAN SIMON, PAMPANGA
Responsibility
MFO/PAP Amount
Center
To record payment of : 32,300.00

MOOE Cash Advance
Period Covered : 43466
SCHOOL: SAN JUAN ES

DISTRICT: SAN SIMON
ACCOUNT NO. 3426-072-547

Amount Due 32,300.00
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.
MARDY B. SALCEDO
TIC
B. Accounting Entry:
Account Title UACS Code Debit Credit
Advances for Operating Expenses 19901010 32,300.00

Cash - MDS, Regular 10104040 32,300.00
C. Certified: D. Approved for Payment

EDILBCash
ü Subject to Authority to Debit Account (when applicable)
JANITORIAL FEE
ü Supp
proper
Signature Signature
Printed
Printed Name
Name Erwin M. Cruz LEONARDO D. ZAPANTA, ED. D, CESO VI
Accountant III Schools Division Superintendent

Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
MARDY B.
Date
SALCEDO
E. Receipt of Payment JEV No.
Check/ Date : Bank Name & Account Number:
ADA No. : LANDBANK/3426-072-547
Date : Printed Name: Date
Signature :
MARDY B. SALCEDO
Official Receipt No. & Date/Other Documents
DEPARTMENT OF EDUCATION
SAN JUAN ELEMENTARY SCHOOL
CASH DISBURSEMENTS REGISTER
Entity Name: SAN JUAN ELEM. SCHOOL Name of Accountable Officer: PORCIA P. SANTIAGO
Sub-Office/Division: Division of Pampanga Official Designation: HEAD TEACHER I
Municipality/District/Province: SAN SIMON Station: 19
Fund Cluster : 01 - Regular Register No. :
Sheet No. : 1 of 1
ADVANCES FOR OPERATING EXPENSE

(19901010) BREAKDOWN OF PAYMENTS RECAPITULATION
DV # / SEMI-
DATE PARTICULARS OFFICE EXPENDABLE
ADA # DRUGS & TELEPHONE OTHER ACCOUNTABLE PETTY CASH
ELECTRIC WATER /SCHOOL TRAVEL TRAINING INTERNET JANITOR SECURITY MACHINERY & DUE TO BIR
CASH ADVANCE PAYMENT BALANCE MEDICINES (MOBILE) MOOE FORMS FUND
SUPPLIES EQPT. ACCOUNT DESCRIPTION UACS CODE AMOUNT
EXPENSES
50204020 50204010 50203010 50201010 50202010 50203070 50205020 50205030 50212020 50212030 50299990 5020321000 50203020 10101020 20201010
Balance Forwarded - 379.60
7-26-18 4828 20,900.00 - 21,279.60 ELECTRIC 50204020 122.68
GLOBE WATER
7-30-18 18-059 TELECOM 1,939.32 19,340.28 1,939.32 - 50204010 -
GLOBE OFFICE /SCHOOL SUPPLIES

7-30-18 18-060 TELECOM 300.00 19,040.28 300.00 - 50203010 4,022.32
ORCHIDS TRAVEL
3/8/18 18-061 BOOKSTORE 4,022.32 15,017.96 4,022.32 257.68 50201010 974.00
TRAINING
7-13-18 18-062 SUSIE'S CUISINE 700.00 14,317.96 700.00 - 50202010 -
DRUGS & MEDICINES

7-14-18 18-063 SUSIE'S CUISINE 515.00 13,802.96 515.00 - 50203070 -
TELEPHONE (MOBILE)
7-14-18 18-064 SUSIE'S CUISINE 70.00 13,732.96 70.00 - 50205020 300.00
JOLLIBEE INTERNET
7-14-18 18-065 FOODS CORP 1,148.00 12,584.96 1,148.00 - 50205030 1,939.32
JOLLIBEE JANITOR
7-13-18 18-066 FOODS CORP 1,200.00 11,384.96 1,200.00 - 50212020 4,000.00
EDILBERTO B. SECURITY
8-17-18 18-067 PANGAN 4,000.00 7,384.96 4,000.00 - 50212030 -
OTHER MOOE
8/3/18 18-068 AIDA ALFARO 500.00 6,884.96 500.00 - 50299990 4,133.00
2/7/18 18-069 PELCO III 122.68 6,762.28 122.68 5.73 REPAIRS - SCHOOL BLDG. 5021304002 -
PORCIA SEMI-EXPENDABLE MACHINERY
7-18-18 18-070 P.SANTIAGO 1,169.45 5,592.83 974.00 - - & EQPT. EXPENSES 5020321000 -
SEMI-EXPENDABLE FURNITURE,
FIXTURES & BOOKS EXPENSES
5,592.83 1.169.45 61.55 5020322000 -
- 5,592.83 FIDELITY BOND PREMIUMS 50215020 -
- 5,592.83 ACCOUNTABLE FORMS 50203020 -
- 5,592.83 PETTY CASH FUND 10101020 -
TOTAL 20,900.00 15,686.87 5,592.83 122.68 - 4,022.32 974.00 - - 300.00 1,939.32 4,000.00 - 4,133.00 - - - 324.96 DUE TO BIR 20201010 (324.96)
CERTIFIED CORRECT RECEIVED BY : TOTAL 15,686.87
5,592.83
PORCIA P. SANTIAGO LEONOR G. GUINTO
HEAD TEACHER I ADAS III
DATE : AUGUST 21,2018 DATE: AUGUST 21,2018
Department of Education SDOPAMP-QF-OSDS-ACC-006
Region III Revision: 00
High School Blvd., Brgy. Lourdes, City of San Fernando Effectivity. date: 05-08-2018
Name of Office:
SUMMARY OF EXPENSE ACCOUNTING
SAN JUAN ELEMENTARY SCHOOL

SAN SIMON DISTRICT
Aug-18
TYPE OF WORKING FUND: MOOE
TAX
DV # OR DATE OR Number SUPPLIER NAME NATURE OF EXPENSE GROSS TOTAL TAX NET
2306 2307
18-059 7-30-2018 0117652 GLOBE TELECOM TELEPHONE BILL 300.00 - 300.00
18-060 7-30-2018 0117653 GLOBE TELECOM INTERNET BILL 1,939.42 - 1,939.42
18-061 3/8/2018 0017553 ORCHIDS BOOKSTORE SPORTS MATERIAL S 4,250.00 189.73 67.95 257.68 4,022.32
18-062 7-13-2018 8566 SUSIE'S CUISINE -BRANCH IVMEALS 700.00 - 700.00
18-065 7-14-2018 0020905 JOLLIBEE FOODS CORP. MEALS 1,148.00 - 1,148.00
18-066 7-13-2018 0020903 JOLLIBEE FOODS CORP. MEALS 1,200.00 - 1,200.00
18-067 8-17-2018 EDILBERTO B. PANGAN JANITORIAL FEE 4,000.00 - 4,000.00
18-068 3/8/2018 AIDA ALFARO RENTAL FEE 500.00 - 500.00
18-069 2/7/2018 0118863 PELCO III ELECTRIC BILL 128.41 5.73 5.73 122.68
18-070 7-18-2018 0103 PRINT M888COPY CENTER AND GEN.MDSE PHIL-IRI MATERIALS 1,231.00 36.93 24.62 61.55 1,169.45
TOTAL 15,981.83 232.39 92.57 324.96 15,686.87
Prepared by:
PORCIA P. SANTIAGO
HEAD TEACHER I
AUGUST 21,2018
EDILBETO B. PANGAN August 17,2018
One Deped… One Pampanga
Appendix 60
PURCHASE REQUEST
Entity Name: SAN AGUSTIN ELEMENTARY SCHOOL Fund Cluster: __________________
Office/Section : _____________ PR No.: ______________ Date: MARCH ,2020

_________________________ Responsibility Center Code : _________
Stock/ Property
Unit Item Description Quantity Unit Cost Total Cost
No.
1 pcs documentary stamps 56
Purpose:
_____________
_____________
_____________
_____________
_____________
_____________ for the diploma/certificate of 28 graduating pupils
_____________
________
_____________
___________
_____________
___________ Requested by: Approved by:
Signature : _________________________ ___________________________
Printed Name : MAXIMA C. SILVA PORCIA P. SANTIAGO
Designation : BAC - CHAIRMAN School Head
Region
DIVISION OF PAMPANGA
City of San Fernando (P)
BIDS AND AWARDS COMMITTEE
"ANNEX A"
Request for Quotation
Date :
EDILBERTO B. PANGAN August 17,2018
To all Eligible Suppliers :
Please quote your lowest price inclusive of VAT on the item/s listed below.Lots listed below, subject to the
JANITORIAL FEE ###
authorized representative not later than at 11:00 am
at
For more information please call , BAC Secretary at Tel. # / CP #
Prospective supplier shall be responsible to verify the quoted items from above stated Office and Tel. No/s.
Note: 1. All Entries shall be type or written ink.

Aug-18
2. Warranty shall be for a period of six(6) months for supplies and materials, One Year(1) for
equipment from date of acceptance by the procuring Entity
3.Mayor's Permit or Business Permit,
shall be attached upon submission of the quotation
4. Price validity shall be for a period of 30 calendar days
5.Our payment term is ____ calendar days
6.Bidders shall submit original brochures showing the product being offered
BAC Chairperson
ITEM QTY. UNIT COMMODITY & DESCRIPTION UNIT PRICE AMOUNT

1
EDILBETO
6 B. PANGAN August 17,2018
7
JANITORIAL FEE 4,000

10
11
12
13
14
15
16 Aug-18
17
______________________________
PORCIA P. SANTIAGO-SCHOOL HEAD EDILBERTO B. PANGAN

20
21
22
23
This is to submit our price quotations as indicated above subject to the terms and conditions
Supplier's Company Name :

Address :
Telephone No. : Email :
Supplier's Authorized Representative

Signature over Printed Name :
Region
City of San Fernando Pampanga
3/8/2018
DATE
ABSTRACT
ABACUS
PANDAYAN ORCHIDS
BOOKS AND
BOOKSHOP BOOKSTORE
CARDS CORP.
QTY UNIT ARTICLE UNIT PRICE UNIT PRICE UNIT PRICE
1 PC SEPAK TAKRAW BALL 770.00 760.00 750.00
1 PC SHOT PUT 3KG 505.00 500.00 490.00
1 PC SHOT PUT 2 KG 298.00 310.00 295.00
1 PC DISCUSS THROW 2KG 780.00 780.00 775.00
1 PC DISCUSS THROW 1.5KG 700.00 704.00 700.00
1 PC CHESS BIG 505.00 512.00 500.00
1 PC JAVELIN 745.00 755.00 780.00
VICTORIA M. MICLAT
BAC Chairman
HELEN B. INGAL ROWENA G. BILLEDO

BAC Member BAC Member
FATIMA A. VALDEZ GLADYS ANNE A. FRANCO

BAC Member BAC Member
APPROVED :
PORCIA P. SANTIAGO
HEAD TEACHER I
BAC Member
BAC Member
Appendix 61
PURCHASE ORDER
Entity Name
Supplier : BUREAU OF INTERNAL REVENUE P.O. No. : ____________________________

Address : SAN FERNANDO ,PAMPANGA Date : MARCH , 2020
TIN : Mode of Procurement :
Gentlemen:
Please furnish this Office the following articles subject to the terms and conditions contained herein:
Date of Delivery : Payment Term :
Stock/ Property No. Unit Description Quantity Unit Cost Amount
1 pcs documentary stamps 56
(Total Amount in Words) TOTAL -
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,
__________________________ PORCIA P. SANTIAGO

Signature over Printed Name of Supplier
Signature over Printed Name of Authorized Official
___________________________ SCHOOL HEAD

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 : SAN JUAN ELEMENTARY SCHOOL Fund Cluster : ___________
Supplier : ______________________________________________ IAR No. : _______________

PO No./Date : ___________________________________________ Date : ______ 3/8/2018
Requisitioning Office/Dept. : _______________________________ Invoice No. : ____________
Responsibility Center Code : _______________________________ August 3,2018
Stock/
Description Unit Quantity
Property No.
1 SEPAK TAKRAW BALL PC 1
2 SHOT PUT 3KG PC 1
3 SHOT PUT 2KG PC 1
4 DISCUSS THROW 2KG PC 1
5 DISCUSS THROW 1.5 KG PC 1
6 CHESS PC 1
7 JAVELIN PC 1
INSPECTION ACCEPTANCE
Date Inspected : ________________________ Date Received : _____________________
Inspected, verified and found in Complete

order as to quantity and
specifications
Partial (pls. specify quantity)
PORCIA P. SANTIAGO GLADYS ANNE A. FRANCO

Inspection Officer/Inspection Committee Supply and/or Property Custodian
Aug-18
Appendix 63
REQUISITION AND ISSUE SLIP
Entity Name : Fund Cluster :

Division : Responsibility Center Code : ______________________
Office : ________________________________________________ RIS No. : ___________________________________
Requisition Stock Available? Issue
Stock No. Description Yes No Quantity Remarks
Purpose:
EDILBETO B. PANGAN
Requested by: Approved by: Issued by: Received by:
Signature :
Designation :
Date :
Appendix 59
REGION III
INVENTORY CUSTODIAN SLIP
Entity / School Name: SAN JUAN ELEMENTARY SCHOOL

Fund Cluster : ICS No :
Amount
Inventory Estimated
Quantity Unit Description
Unit Cost Total Cost Item No. Useful Life
1 pcs
1 pcs
1 pcs
1 pcs
1 pcs
1 pcs
1 pcs
1 pcs
1 pcs
Accountability over Semi-expendable Property. Inventory Custodian Slip (ICS) shall be issued to
end-user of Semi-expendable Property to establish accountability. Accountability shall be
JANITORIAL FEE
extinguished upon return of the item to4,000.00
the Asset Management Division (AMD) or in case of
loss, upon approval of the relief from property accountability.
Received from: Received by:
Signature Over Printed Name Signature Over Printed Name

PROPERTY CUSTODIAN
______________________________ Position/Office
PORCIA P. SANTIAGO-SCHOOL HEAD
Date Date
Region III
High School Blvd., Brgy. Lourdes, City of San Fernando
PROGRAM OF WORKS
PROJECT:
SCHOOL:
LOCATION:
SOURCE OF FUND:
DATE:
UNIT COST
ITEM NO. DESCRIPTION UNIT QTY GRAND TOTAL REMARKS
MATERIAL
A MATERIALS COST
0.00
0.00
0.00
0.00
0.00
0.00
B LABOR COST No. of Days

0.00
0.00
Sub Total Labor 0.00
I. TOTAL MATERIALS COST 0.00

II. TOTAL LABOR COST 0.00
III. EQUIPMENT COST 0
IV. TOTAL PROJECT COST 0.00
Prepared by: Checked:
School Physical Facilities Coordinator School Head
Approved:
LEONARDO D. ZAPANTA, ED., D. CESO VI

Division Engineer Schools Division Superintendent
Appendix 65
WASTE MATERIALS REPORT
Entity Name : SAN AGUSTIN ELEMENTARY SCHOOL

Place of Storage : Date :
ITEMS FOR DISPOSAL
Record of Sales
Item Quantity Unit Description Official Receipt
No. Date Amount
1
2
3
4
5
6
7
8
9
10
TOTAL
Certified Correct : Disposal Approved :
__________________________________
Signature over Printed Name of Signature over Printed Name of Head of
Supply and/or Property Custodian Agency/Entity or his/her Authorized
Representative
CERTIFICATE OF INSPECTION
I hereby certify that the property enumerated above was disposed of as follows:
Item ________ Destroyed

Item ________ Sold at private sale
Item ________ Sold at public auction
Item ________ Transferred without cost to __(Name of the Agency/Entity)__
Certified Correct: Witness to Disposal:
Signature over Printed Name of Signature over Printed Name

Inspection Officer of Witness
Aug-18
______________________________
PO EDILBERTO B. PANGAN
EDILBERTO B. PANGAAugust 17,2018
Aug-18
EDILBERTO B. PANGAN
EDILBETO B. PANGANAugust 17,2018

Aug-18
______________________________
EDILBERTO B. PANGAN
Aug-18
EDILBERTO B. PANGAN

Aug-18
______________________________
EDILBERTO B. PANGAN
Department of Education SDOPAMP-QF-OSDS-ACC-
Region III 009
Revision: 00
Name of Office:
ACKNOWLEDGEMENT RECEIPT ACCOUNTING
Received from PORCIA P. SANTIAGO,HT-I OF SAN AGUSTINE/S the amount of
one thousand six hundred eighty pesos P 1,680.00
representing payment of : (detailed description of the nature of disburement)
56 documentary stamps
Received by: (signature over printed name)

Department of Education SDOPAMP-QF-OSDS-ACC-
Region III 009
Revision: 00
Name of Office:
ACKNOWLEDGEMENT RECEIPT ACCOUNTING
Received from PORCIA P. SANTIAGO/HT-I OFSAN AGUSTIN ES the amount of
one thousand six hundred eighty pesos P 1,680.00
representing payment of : (detailed description of the nature of disburement)
56 documentary stamps
Received by: (signature over printed name)

CERTIFICATION OF TRAVEL COMPLETED
Entity Name : Fund Cluster :
Officer in-Charge Station
I HEREBY CERTIFY that I have completed the travel as authorized in the Travel
Order/Itinerary of Travel No. dated under conditions indicated below:
EDIL August 17,2018
/ x / Strictly in accordance with the approved itinerary.
/ / Cut short as explaoned below. Excess Payment on the amount of
### P
JANITORIAL was refunded under O.R. No. dated
/ / Extended as explained below, additional itinerary was submitted
/ / Other deviation as explained below.
Explanation or justifications:
Evidenc
###
EDILBERTO B. PANGAN
Respectfully submitted:
Name of Employee
On evidence and information of which I have the knowledge, the travel was actually undertaken.
Approved :
EDIL August 17,2018

Head of Office
JANITORIAL
###
###
______________________________
EDILBERTO B. PANGAN
Aug-18
EDILBERTO B. PANGAN

Aug-18
______________________________
EDILBERTO B. PANGAN
Appendix 45
ITINERARY OF TRAVEL
Entity Name :
Fund Cluster: No.: _______________
Name : Date of Travel :

Position : Purpose of Travel :
Official Station :
EDILBERTO B. PANGAN August 17,2018 ___________________________________________
Places to be visited TIME Means of Transpor- Per Total
Date Others
(Destination) Departure Arrival Transportation station Diem Amount
EDILBERTO B. PANGAN
JANITORIAL FEE 0:00
TOTAL -
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.
Signature over Printed Name
____________________________________
Signature over Printed Name
Immediate Supervisor
Appendix 45
ITINERARY OF TRAVEL
Entity Name :
Fund Cluster: No.: _______________
Name : Date of Travel :

Position : Purpose of Travel :
Official Station :
EDILBERTO B. PANGAN August 17,2018 ___________________________________________
Places to be visited TIME Means of Transpor- Per Total
Date Others
(Destination) Departure Arrival Transportation station Diem Amount
JANITORIAL 4,000.00
Aug-18
EDILBERTO B. PANGAN
JANITORIAL FEE 0:00
TOTAL -
Prepared by :
I certify that : (1) I have reviewed the foregoing _____________________________________________

itinerary, (2) the travel is necessary to the service, Signature over Printed Name
(3) the period covered is reasonable and (4) the
expenses claimed are proper.
Approved by:
____________________________________ ______________________________________________
Signature over Printed Name Signature over Printed Name
Immediate Supervisor Agency Head/Authorized Representative
Document Code: SDO-QF-OSD-PER-072
Schools Division Office of Pampanga
Effectivity date: MAY 08, 2018
Name of Office:
PERSONNEL LOCATOR SLIP PERSONNEL
CERTIFICATE OF APPEARANCE:
I hereby certify that the requesting
DESTINATION Note: For personal business state reason personnel appeared in this office on
and place Official Business.
Purpose ____OB __Personal Authorized Signature Date
___ Division Office
___ Regional Office
___ BIR _________________________________
___ GSIS _________________________________
___ PHILHEALTH _________________________________
___ others _________________________________
_________________________________
_________________________________
Requested by: Approved by:

TIME:
Name / Signature
Departure
Arrival Name / Signature
Date
Document Code: SDO-QF-OSD-PER-072

Schools Division Office of Pampanga
JAN Effectivity date: MAY 08, 2018
Name of Office:
PERSONNEL LOCATOR SLIP PERSONNEL
CERTIFICATE OF APPEARANCE:
I hereby certify that the requesting
DESTINATION Note: For personal business state reason personnel appeared in this office on
and place Official Business.
Purpose ____OB __Personal Authorized Signature Date
___ Division Office
___ Regional Office
___ BIR _________________________________
___ GSIS _________________________________
___ PHILHEALTH _________________________________
___ OTHERS _________________________________
_________________________________
_________________________________
Requested by: Approved by:

TIME:
Name / Signature
Departure
Arrival Name / Signature
Date
Aug-18
EDILBERTO B. PANGAN

Aug-18
______________________________
EDILBERTO B. PANGAN

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ANNEX A

CASH ADVANCE REQUEST

Billing Statement(Original only) attached photocopy

INTERNET AND TELEPHONE

TELEPHONE - Mobile (MAX. P300.00 ONLY)

PURCHASES - SHOPPING MODE

REPAIRS AND MAINTENANCE

SECURITY AND JANITORIAL SERVICES

ID (P50.00 per student)

Inspection And Acceptance Report (With attached

Issued by: Property Custodian Issued by: Property Custodian

Use of Acknowledgement Receipt (AR)

Transactions where AR can be used:

Payee/Office: MARDY B. SALCEDO No:

To obligate payment of : 32,300.00

SCHOOL: SAN JUAN ES

MARDY B. SALCEDO REMEDIOS M. BACANI

CASH ADVANCE 32,300.00 32,300.00

SAN SIMON DISTRICT

56-DOCUMENTARY STAMPS 1,680.00

Republic of the Philippines Document Code:

SAN SIMON DISTRICT

CASH DISBURSEMENT VOUCHER

56 DOCUMENTARY STAMPS 1,680.00

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

To record payment of : 32,300.00

SCHOOL: SAN JUAN ES

ACCOUNT NO. 3426-072-547

Advances for Operating Expenses 19901010 32,300.00

C. Certified: D. Approved for Payment

Accountant III Schools Division Superintendent

ADVANCES FOR OPERATING EXPENSE

GLOBE OFFICE /SCHOOL SUPPLIES

DRUGS & MEDICINES

SAN JUAN ELEMENTARY SCHOOL

TOTAL 15,981.83 232.39 92.57 324.96 15,686.87

Entity Name: SAN AGUSTIN ELEMENTARY SCHOOL Fund Cluster: __________________

Office/Section : _____________ PR No.: ______________ Date: MARCH ,2020

BIDS AND AWARDS COMMITTEE

Note: 1. All Entries shall be type or written ink.

ITEM QTY. UNIT COMMODITY & DESCRIPTION UNIT PRICE AMOUNT

JANITORIAL FEE 4,000

PORCIA P. SANTIAGO-SCHOOL HEAD EDILBERTO B. PANGAN

Supplier's Company Name :

Supplier's Authorized Representative

HELEN B. INGAL ROWENA G. BILLEDO

FATIMA A. VALDEZ GLADYS ANNE A. FRANCO

Supplier : BUREAU OF INTERNAL REVENUE P.O. No. : ____________________________

Date of Delivery : Payment Term :

Stock/ Property No. Unit Description Quantity Unit Cost Amount

1 pcs documentary stamps 56

(Total Amount in Words) TOTAL -

Conforme: Very truly yours,

__________________________ PORCIA P. SANTIAGO

___________________________ SCHOOL HEAD

Fund Cluster : ___________________________________ ORS/BURS No. : ______________________

INSPECTION AND ACCEPTANCE REPORT

Office/Section : _ PR No.: __ Date: MARCH ,2020

Fund Cluster : _____________ ORS/BURS No. :

Supplier : ________________________________ IAR No. : _

_ BIR _______________________________

_ GSIS _______________________________

_ PHILHEALTH _______________________________

_ others _______________________________

_ BIR _______________________________

_ GSIS _______________________________

_ PHILHEALTH _______________________________

_ OTHERS _______________________________