DepEd, Masbate Province Fund Cluster:

DISBURSEMENT VOUCHER
Date: January 29 2020
DV No.:
Mode of
Paypment MDS Commercial Check ADA Other (please specify)

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

Payee Karen Kates A. Barrameda

Address Gibraltar, Batuan, Masbate

Particulars Responsibility MFO/PAP Amount

Center

To reimbursement of my travel expenses incurred while on official

business as per supporting papers attached in the amount of
………………………… -
A
.

Amount Due 0
Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision
B

ANTONIO C. REFERMOSO
School Head
Printed Name, Designation and Signature of Supervisor
C Accountability Entry: D
Account Title UACS Code Debit Credit

Certified: Approved for Payment

Cash Available
E
Subject to Authority to Debit Account (when applicable)

Supporting documents complete and amount claimed proper

Signature Signature
Printed Name Printed Name ANTONIO C. REFERMOSO
Position Bookkeeper Position School Head
Date January 29 2020 Date January 29 2020
. JEV No.
Check/ADA Date: Bank Name & Account Number:
No.:

Signature Date: Printed Name: Date:

January 29 2020 Karen Kates A. Barrameda January 29 2020

Official Receipt No. & Date/Other Documents

 Department of Education
DIVISION OF MASBATE
Masbate

NAME: Karen Kates A. Barrameda Position: Teacher I

SALARY: Station:
PURPOSE OF TRAVEL:

ITINERARY OF TRAVEL

TIME ALLOTMENT EXPENSES

Name of
DATE Place to be Visited TOTAL AMOUNT
Departure Arrival Transportation Transportation Per Diem

SUBTOTAL - - -

SUBTOTAL - - -

GRAND TOTAL - - -
I hereby certify that: (1) I have reviewed the
foregoing itinerary, (2) the travel is necessary to the
service, (3) the period covered is reasonable and Karen Kates A. Barrameda
(4) the expenses claimed are proper. Official/Employee

ABRAHAM R. VELASCO III ANTONIO C. REFERMOSO

Disbursing Officer-Designate Official/Employee/School Head
 Republic of the Philippines
Department of Education
Region V
DIVISION OF MASBATE
Masbate

Appendix 21

CERTIFICATE OF TRAVEL COMPLETED

NENE R. MERIOLES, CESO V DepEd, Division of Masbate

Schools Division Superintendent
Date: January 29 2020

I certify that I have completed the travel authorized in Itinerary of Travel no. _____________________ Dated January 29 2
under conditions indicated below:

□  Strictly in accordance with approved itinerary

□  Cut short as explained below, Excess payment in the amount of P____________
Was refunded under O.R. No. _____________
□  Extended and explained below, additional itinerary was submitted
□  Other deviation was explained below
□  Explanation of justification: Travel completed:

EVIDENCE OF TRAVEL

□  Used Tickets
□  Certificate of Appearance
□  Other: Travel Order
□  Memorandum
□  RER

Respectfully submitted:

Karen Kates A. Barrameda

Official or Employee

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

APPROVED:

ANTONIO C. REFERMOSO
Principal /School Head
 Republic of the Philippines
Region V
Division of Masbate
DISTRICT OF BATUAN
Batuan

TRAVEL ORDER TO:

Karen Kates A. Barrameda

Teacher I
ALLSIS

SUBJECT 0

(Purpose of Travel)

You are hereby advised to report the

(Office)
Division of Masbate on January 29 2020 to transact business stated above.

ANTONIO C. REFERMOSO
Principal
 ANNEX A ANNEX B

REPUBLIC OF THE PHILIPPINES REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF EDUCATION DEPARTMENT OF EDUCATION
REGION V REGION V
DIVISION OF MASBATE DIVISION OF MASBATE

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

Name of Employee Karen Kates A. Barrameda Employee No. Name of Employee Karen Kates A. Barrameda Employee No.
Office Office
Division MASBATE PROVINCE Division MASBATE PROVINCE
Particulars Amount (P) Particulars Amount (P)
0 0
0 - 0 -
0 - 0 -

TOTAL - TOTAL -
Purpose 0 Purpose 0

I hereby certify that the above expenses are incurred as they are necesarry for the above cited I hereby certify that the above expenses are incurred as they are necesarry for the above cited
purpose, that the above goods and services were acquired from parties not issuing receipts. And that I purpose, that the above goods and services were acquired from parties not issuing receipts. And that I
am fully aware that wilful falsification of statements is punishable by law. am fully aware that wilful falsification of statements is punishable by law.
Certified Correct: Noted by: Certified Correct: Noted by:
Signature Signature

Printed Name Printed Name

Karen Kates A. Barrameda ANTONIO C. REFERMOSO Karen Kates A. Barrameda ANTONIO C. REFERMOSO
Employee Immediate Supervisor Employee Immediate Supervisor
Date 12/30/1899 Date 12/30/1899 Date 12/30/1899 Date 12/30/1899