(Agency Name) (Agency Name)

CERTIFICATE OF EXPENSES NOT REQUIRING RECEIPTS CERTIFICATE OF EXPENSES NOT REQUIR

Pursuant to COA Circular No. 2017-001 dated June 19, 2017 Pursuant to COA Circular No. 2017-001 dated Ju
Name of Employee Employee No. Name of Employee
Office Office
Division Division
Particulars Amount (₱) Particulars

TOTAL TOTAL
Purpose Purpose

I hereby certify that the above expenses are incurred as they are necessary for the I hereby certify that the above expenses are incurred as they are
above cited purpose, that above goods and services were acquired from parties not cited purpose, that above goods and services were acquired fr
issuing reciepts. And that I am fully aware that witful falsification of statements is reciepts. And that I am fully aware that witful falsification of sta
punishable by law. law.

Certified correct: Noted by: Certified correct:

Signature Signature

Printed Nam Printed Name

Employee Immediate Supervisor Employee
Date Date Date

(Agency Name) (Agency Name)

CERTIFICATE OF EXPENSES NOT REQUIRING RECEIPTS CERTIFICATE OF EXPENSES NOT REQUIR

Pursuant to COA Circular No. 2017-001 dated June 19, 2017 Pursuant to COA Circular No. 2017-001 dated Ju
Name of Employee Employee No. Name of Employee
Office Office
Division Division
Particulars Amount (₱) Particulars
 TOTAL TOTAL
Purpose Purpose

I hereby certify that the above expenses are incurred as they are necessary for the I hereby certify that the above expenses are incurred as they are
above cited purpose, that above goods and services were acquired from parties not cited purpose, that above goods and services were acquired fr
issuing reciepts. And that I am fully aware that witful falsification of statements is reciepts. And that I am fully aware that witful falsification of sta
punishable by law. law.

Certified correct: Noted by: Certified correct:

Signature Signature

Printed Nam Printed Name

Employee Immediate Supervisor Employee
Date Date Date
 (Agency Name)

E OF EXPENSES NOT REQUIRING RECEIPTS

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

Amount (₱)

the above expenses are incurred as they are necessary for the above
t above goods and services were acquired from parties not issuing
m fully aware that witful falsification of statements is punishable by
law.

Certified correct: Noted by:

Employee Immediate Supervisor

Date

(Agency Name)

E OF EXPENSES NOT REQUIRING RECEIPTS

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

Amount (₱)
the above expenses are incurred as they are necessary for the above
t above goods and services were acquired from parties not issuing
m fully aware that witful falsification of statements is punishable by
law.

Certified correct: Noted by:

Employee Immediate Supervisor

Date