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ANNEX A

REPUBLIC OF THE PHILIPPINES


DEPARTMENT OF AGRARIAN REFORM
Tunay na Pagbabago sa Repormang Agraryo

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS


Pursuant to COA Circular No. 2017-001 dated June 19, 2017

Name of Employee JOELYN M. ESCALANTE Employee No.


Office DAR
Division LTSP
Particulars Amount (Php)

Pagadian - Josefina (September 21, 2020) 150.00


Josefina - Pagadian (September 21, 2020) 150.00
Pagadian - Dumingag (September 22, 2020) 130.00
Dumingag - Pagadian (September 22, 2020) 130.00
Pagadian - Mahayag (September 23, 2020) 120.00
Mahayag - Pagadian (September 23, 2020) 120.00
Pagadian - Aurora (September 24, 2020) 130.00
Aurora - Pagadian (September 24, 2020) 130.00
Pagadian - Midsalip (September 25, 2020) 100.00
Midsalip - Pagadian (September 25, 2020) 100.00

TOTAL 1,260.00
Purpose:
Secure/gather documents needed for the documentation of LADIS Folder.

I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose, that 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.

Certified correct: Noted by:


Signature
Printed Name JOELYN M. ESCALANTE ENGR. JENA C. SALAUG
Employee CARPO LTSP
Date Date

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