Appendix 32

Fund Cluster :
Republic of the Philippines
Department of Education
DIVISION OF BULACAN 101101
City of Malolos
Date : July 15, 2021
DISBURSEMENT VOUCHER DV No. :

Mode of Payment MDS Check Commercial Check ADA Others (Please specify)
_________________
SAN AGUSTIN ELEMENTARY SCHOOL TIN/Employee No.: ORS/BURS No.:
Payee
CA 0102-1151-12
Address SAN AGUSTIN, SAN RAFAEL, BULACAN

Responsibility
Particulars MFO/PAP Amount
Center
To cash advance the Additional MOOE 47,500.00
Account Name Account Code Total

Medical Expense 50203080 47,500.00

Total 47,500.00 47,500.00

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

CLARISSA S. DE GUZMAN
Head Teacher III
B. Accounting Entry:
Account Title UACS Code Debit Credit
Advances for Operating Expenses 19901010 47,500.00
Cash in Bank - MDS 10104040 47,500.00
C. Certified: D. Approved for Payment
Cash available
Subject to Authority to Debit Account (when applicable)
Supporting
proper

Signature Signature

Printed Name Printed Name

AGNES M. SEIFNEZHAD ZENIA G. MOSTOLES,EdD,CESO V
Accountant III Schools Division Superintendent
Position Head, Accounting Unit/Authorized Representative Position Agency Head/Authorized Representative

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

Official Receipt No. & Date/Other Documents

Document Code: SDO-BUL-QF-OSDS-ACC-001
Revision No.: 03
Effectivity Date: 03-11-2019
 Appendix 11

OBLIGATION REQUEST AND STATUS Serial No. : _101-19-09____

Date :___- -2019_____________
LYDIA D. VILLANGCA ELEMENTARY SCHOOL
Entity Name Fund Cluster : ___101101___________

Payee
LYDIA D. VILLANGCA ELEMENTARY SCHOOL CA 000102-1137-64
Office
LYDIA D. VILLANGCA ELEMENTARY SCHOOL
Address
ULINGAO, SAN RAFAEL, BULACAN
UACS Object
Responsibility Center Particulars MFO/PAP Amount
Code
To cash advance of MOOE fund of Lydia D. Villangca ES
for the month of December, 2019 30,131.44
Account Name Account Code Total

electricity expense 5-02-04-020 5531.44

Water 5-02-04-020 3000.00
PLDT Internet 5-02-05-030 2199.00
Utility November 0 4000.00
Repair and Maintenance 5-02-13-040-02 9000.00
Labor 5-02-13-040-02 2800.00
School Supplies 0 2801.00
Travel Expense DBM 5-02-01-010 800.00

Total 30131.44 30,131.44

A. Certified: Charges to appropriation/alloment are B. Certified: Allotment available and obligated
necessary, lawful and under my direct supervision;and for the purpose/adjustment necessary as
supporting documents valid, proper and legal indicated above

Printed Name:
Signature : ___________________________________ Signature : ______________________________
LANNIE N.
PEREGRINO LANNIE N. PEREGRINO Printed Name: ALICE A. ALMAZAR
Position : School Principal Position : Budget Officer

Head, Requesting Office/Authorized Representative Head, Budget Division/Unit/Authorized

Representative
Date : ___________________________________ Date : ____________________________

C. STATUS OF OBLIGATION
Reference Amount
Balance
ORS/JEV/Check/ Obligation Payable Payment Due and
Date Particulars Not Yet Due
ADA/TRA No. Demandable
(a) (b) (c) (a-b) (b-c)

Document Code: SDO-BUL-GQF-OSDS-ACC-002

Revision No.: 02

Effectivity Date: 03-11-2019

 Appendix 11

OBLIGATION REQUEST AND STATUS Serial No. : _____________________

SCHOOLS DIVISION OF BULACAN Date : July 15, 2021

Entity Name Fund Cluster : ___________________

Payee
DAGAT-DAGATAN ELEMENTARY SCHOOL LBP Current Account No. 0102-1160-54
Office
DAGAT-DAGATAN ELEMENTARY SCHOOL
Address
DAGAT-DAGATAN ,SAN RAFAEL, BULACAN
Description of TO PAYMENT MOOE DOWNLOADING FOR THE ADDITIONAL MOOE
Transaction/(s)
Responsibility UACS Object
Particulars MFO/PAP Amount
Center Code

Medical Expense 50203080 47,500.00

Total 47,500.00
A. Certified: Charges to appropriation/alloment are B. Certified: Allotment available and obligated
necessary, lawful and under my direct supervision;and for the purpose/adjustment necessary as
supporting documents valid, proper and legal indicated above

Signature : ______________________________ Signature : ______________________________

YOLANDA L. VALDIZNO Printed Name: ALICE A. ALMAZAR

Position : Head Teacher I/School Head Position : Budget Officer

Head, Requesting Office/Authorized Representative Head, Budget Division/Unit/Authorized

Representative
Date : ___________________________________ Date : ____________________________

C. STATUS OF OBLIGATION
Reference Amount
Balance
ORS/JEV/Check/ Obligation Payable Payment Due and
Date Particulars Not Yet Due Demandable
ADA/TRA No.
(a) (b) (c) (a-b) (b-c)
36812.5
#REF! 47500 6087.89
#REF! -10687.5 105.66
-7633.9286 256.85
#REF! -3053.5714 5725.38

#REF!
24304.17
 Department of Education
Region III
Division of Bulacan
District of San Rafael
SAN AGUSTIN ELEMENTARY SCHOOL
San Agustin , San Rafael, Bulacan

ESTIMATED AMOUNT OF EXPENDITURES FOR THE MONTH OF

Additional MOOE

Particulars Account Code Amount

Medical Expense 50203080 47,500.00
-
-
-
-
-

Total 47,500.00

Prepared by:

CLARISSA S. DE GUZMAN
Head Teacher III
5020502001
Name DEPED Bulacan- Lydia D. Villangca ES AGENCY
Address of Ulingao ACCOUNT CODE
Agency San Rafael, Bulacan AGENCY CONTROL NO.
PS APR NO.
AGENCY PROCUREMENT REQUEST
TO; THE PROCUREMENT SERVICE
CENTRAL LUZON REGIONAL DEPOT
CITY OF SAN FERNANDO, PAMPANGA
ACTION REQUESTED ON THE ITEM LISTED BELOW
( ) Please furnish with the Price Estimate (for office equipment/furniture & Supplementary items)
( ) Please purchase for our agency the equipment/furniture/supplementaryitems for your price Estimate
( PS RAD No. ________________ attached) dated ________________, _________________
( ) Please issue common -use supplies/ materials per price list as of ________________
( ) Please issue certificate or Reasonableness
( ) Please furnish us with your latest/ updated Price
( ) others ( Specify) ______________________________________________
IMPORTANT!!! PLEASE SEE THE INSTRUCTIONS AT THE BACK OF ORIGINAL COPY.
ITEM NO. ITEM AND DESCRIPTION/SPECIFICATION QTY UNIT UNIT PRICE AMOUNT
1 Alcohol 20 bottle
2 Facemask 5 box
3 anti bacterial soap 10 pcs

TOTAL AMOUNT 4,375.12

Stocks requested are certified FUNDS CERTIFIED AVAILABLE: APPROVED:
to be within approved program:

JOHN RENIEL D. MENDOZA LANNIE N. PEREGRINO

AGENCY PROPERTY SUPPLY OFFICER AGENCY HEAD

( ) FUND DEPOSITE WITH PS ( ) ___________ Check No. ________________________

IN THE AMOUNT OF ________________________________________ ( P ____________)
ENCLOSED
1560

245
245

15458.81
 Republic of the Philippines
Department of Education
Region III
DIVISION OF BULACAN
City of Malolos

PURCHASE REQUEST
School: Lydia D. Villangca Elementary School PR No. : December 3,2018
Section: SAI No. : ________ Date: ________

Stock Unit of Item Description QTY Estimated Unit Estimated Cost

No. Issue Cost
1 meter Electric wire 20 50.00 1,000.00
2 pcs 5 watts led bulb 5 250.00 1,250.00
3 pcs receptacle 5 150.00 750.00
4 pcs switch 5 285.25 1,426.25
5 roll electric tape 2 20.00 40.00

4,466.25
Purpose/ Remarks: TOTAL
Requested by: Approved by:
Signature:
Printed Name: JOHN RENIEL D. MENDOZA LANNIE N. PEREGRINO
Designation: Property Custodian School Principal I
Date:
 4,466.25
199.39
39.88
4,226.99
3672.40

Err:509
1131.06 1131.06 431.06
90.33 431.06 50.49
50.49 10.1
10.10
1070.47 1070.47

4900

Err:509 5086.12
Err:509 2543.06
Err:509
Err:509
Err:509 6614.27
Err:509
 Republic of the Philipines
Department of Education
Region III
Division of Bulacan
District of San Rafael
LYDIA D. VILLANGCA ELEMENTARY SCHOOL
Ulingao San Rafael Bulacan

Program of Works
Name of School: LYDIA D. VILLANGCA ELEMENTARY SCHOOL
Materials Labor
No Descriptive of Work
QTY UNIT ARTICLES PRICE AMOUNT Scheme Cost Total Cost
1 Repair of Office Flooring 8 box 60x60 tiles 592.00 4,736.00 0.00 4,736.00
( second phase)
10 bag tile adhesive 250.50 2,505.00 2,505.00
0.5 elf S1 2,500.22 1,250.11 1,250.11
5 bag Cement 220.00 1,100.00 1,100.00
2 roll tile grout 200.00 400.00 400.00
4 pcs led light 147.25 589.00 589.00

Total 10580.11 0.00 10580.11

Prepared: Certified True and Correct:

LAARNI S. DADO
Industrial Arts Teacher LANNIE N. PEREGRINO
School Principal I
4000.00
0.00
4000.00
 Republic of the Philippines
Department of Education
Region III
DIVISION OF BULACAN
City of Malolos

PURCHASE REQUEST
School: PULONG BAYABAS Elementary School PR No. : 1-Apr-18
Section: SAI No. : ________ Date: ________

Stock Unit of Item Description QTY Estimated Unit Estimated Cost

No. Issue Cost
1 pcs cash box 1 1,560.00 1,560.00
2 pcs bar pin 85 10.00 850.00
3 pcs medal with deped logo 14 90.00 1,260.00

3,670.00
Purpose/ Remarks: TOTAL
Requested by: Approved by:
Signature:
Printed Name: TERESA S. REGANA LANNIE N. PEREGRINO
Designation: Property Custodian Head Teacher I
Date:
 90.33
207.15
195.33

4900

Err:509 5086.12
Err:509 2543.06
 JLO Hardware & Construction Supply
Carlos F. Gonzales St., Galas Maasim San Rafael Bulacan
Tin: 102-239-610-000 Tel. No. 815-2610

Sold to: PULONG BAYABAS ELEMENTARY SCHOOL

QTY UNIT DESCRIPTION Unit Price Amount

153 pc hollowblock 4" 9.00 1377.00
10 pcs Iron (Bakal) 10mm 132.00 1320.00
16 pcs cement 210.00 3360.00
0.5 elf S1 2,000.00 1000.00
10 pcs Iron (Bakal) 8mm 120.00 1200.00
1 roll alambre 207.15 207.15
0.5 elf 3/4 Gravel 2,000.00 1000.00
0.5 kl nail 2" 180.00 90.00

Total Amount 9554.15

Received:
______________________
Authorized Signature
350
400
116 140
93
60
60

Err:509
Err:509
_ Department of Education
Region III
Division of Bulacan
District of San Rafael
PULONG BAYABAS ELEMENTARY SCHOOL
Pulong Bayabas, San Rafael, Bulacan

AUTHORIZATION

To Whom It May Concern:

This is to authorize Mrs. Jannet R. Viola, District Liaison Officer of San Rafael
District, to get/claim the check for my MOOE/Downloading. This letter authorized her
with my permission and awareness.
Hoping for your kind consideration.

Respectfully yours,

WILLIAM C. ORTEGA
District Supervisor
 Department of Education
Region III
Division of Bulacan
DISTRICT OF SAN RAFAEL
Libis, San Rafael, Bulacan

July 05, 2012

AUTHORIZATION

To Whom It May Concern:

This is to authorize Mr. ARTEMIO P. ALBERTO, Elementary School Principal

II of Salapungan Elementary School, to claim/get the Air Conditioner Unit at your good
office.
This letter authorized him with my permission and awareness.
Hoping for your kind consideration.

Respectfully yours,

MARCELO V. LEGASPI
District Supervisor
Name DEPED Bulacan- PASONG INTSIK E/S AGENCY
Address of Pasong Intsik ACCOUNT CODE
Agency San Rafael, Bulacan AGENCY CONTROL NO.
PS APR NO.
AGENCY PROCUREMENT REQUEST
TO; THE PROCUREMENT SERVICE
CENTRAL LUZON REGIONAL DEPOT
CITY OF SAN FERNANDO, PAMPANGA
ACTION REQUESTED ON THE ITEM LISTED BELOW
( ) Please furnish with the Price Estimate (for office equipment/furniture & Supplementary items)
( ) Please purchase for our agency the equipment/furniture/supplementaryitems for your price Estimate
( PS RAD No. ________________ attached) dated ________________, _________________
( ) Please issue common -use supplies/ materials per price list as of ________________
( ) Please issue certificate or Reasonableness
( ) Please furnish us with your latest/ updated Price
( ) others ( Specify) ______________________________________________
IMPORTANT!!! PLEASE SEE THE INSTRUCTIONS AT THE BACK OF ORIGINAL COPY.
ITEM NO. ITEM AND DESCRIPTION/SPECIFICATION QTY UNIT UNIT PRICE AMOUNT
1 Printer 1 pc
2 USB 1 pc
3 sign pen 1 pc

TOTAL AMOUNT 7459.37

Stocks requested are certified FUNDS CERTIFIED AVAILABLE: APPROVED:
to be within approved program:

_____________________________ ______________________
AGENCY PROPERTY SUPPLY OFFICER AGENCY HEAD

( ) FUND DEPOSITE WITH PS ( ) ___________ Check No. ________________________

IN THE AMOUNT OF ________________________________________ ( P ____________)
ENCLOSED