Appendix 44

LIQUIDATION REPORT Serial No.: ___________________

Period Covered__________________________ Date: November 9, 2022

Entity Name: Department of Education, Regional Office 6 Responsibility Center Code:

Fund Cluster: General Fund

PARTICULARS AMOUNT

Liquidation of cash advance under Basic Education Research Fund

for the release of 1st Tranche.

4,500.00
Ref: ADA
LDDAP No. 101-12 1012-2021 dated 12/29/202
Payee: MICHELLE C. JANDAYRAN
Bololacao National High School
Amount: Php 4500.00

TOTAL AMOUNT SPENT ₱4,928.25

AMOUNT OF CASH ADVANCE PER DV NO. DTD. ₱4,500.00
AMOUNT REFUNDED PER OR NO. DTD.
AMOUNT TO BE REIMBURSED ₱428.25
A Certified: Correctness B Certified: Purpose of travel/ C Certified: Supporting
of the above data cash advance duly accomplished documents complete and proper

MICHELLE C. JANDAYRAN JENNIFER E. TEJERESO ROY B. CASTRO JR.

TEACHER I PRINCIPALI/ 0IC Accountant III
Signature over Printed Name Signature over Printed Name
Claimant
Immediate Supervisor Head, Accounting Unit

JEV No.:
Date: _________________________Date: _____________________ Date: _______________________
 SUMMARY OF EXPENSES
Basic Education Research Fund

Amount Granted Ck# _________dated ___________

Less: Expenses

Date Particulars O.R No. Amount

January 3, 2022 Supplies 000777 105.00 ₱105.00
January 3, 2022 Supplies 000781 1892.50 ₱1,892.50
January 17, 2022 Snacks 001351 87.00 ₱87.00
January 17, 2022 Snacks 0000852 103.00 ₱103.00
January 18, 2022 Snacks 001322 87.00 ₱87.00
January 18, 2022 Snacks 0000350 73.00 ₱73.00
January 19, 2022 Snacks 001899 87.00 ₱87.00
January 20, 2022 Travel Certification 110.00 ₱110.00
January 20, 2022 Travel Certification 110.00 ₱110.00
January 20, 2022 Travel Certification 110.00 ₱110.00
January 20, 2022 Travel Certification 150.00 ₱150.00
January 20, 2022 Travel Certification 150.00 ₱150.00
January 20, 2022 Travel Certification 150.00 ₱150.00
March 9, 2022 Snacks 001452 495.00 ₱495.00
March 16, 2022 Snacks 0000368 498.75 ₱498.75
June 20, 2022 Travel Certification 240.00 ₱240.00
June 20, 2022 Travel Certification 240.00 ₱240.00
June 20, 2022 Travel Certification 240.00 ₱240.00

Total Expenses ₱4,928.25

Amount to be reimbursed ₱428.25

Prepared by:

MICHELLE C. JANDAYRAN
Researcher
Note:
Amount to be reimbursed = total expenses - first tranche
 Republic of the Philippines
Department of Education
REGION VI - WESTERN VISAYAS
Duran Street, Iloilo City

ITINERARY OF TRAVEL

Name:
Position
Official Station:
Purpose:

Venue:

DATE Place to be TIME

visited Departure Arrival

TOTAL

I HEREBY CERTIFY THAT: (1) have reviewed the foregoing itinerary; 2) that travel is necessary
to the services; 3) the period covered is reasonable and(4) the expenses claimed are proper.

APPROVED:
 es
on
AYAS
y

Means of ALLOWABLE EXPENSES TOTAL

Transpo. Transportation Per Diems AMOUNT

tinerary; 2) that travel is necessary

Prepared by:
 DEPARTMENT OF EDUCATION
Region Vi- Western Visayas
Duran St., Iloilo City

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS

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

Name of Employee Employee No.:

Office

Division

Particulars Amount

Total
Purpose:

Include the date of travel

I hereby verify 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
willful falsification of statements is punishable by law.

Certified Correct: Noted by:

Signature

Printed Name
Employee Date