Republic of the Philippines

Department of Education
DIVISION OF SOUTHERN LEYTE
R. Kangleon St., Mantahan,Maasin City

SL DO Form No. 31
SOGOD 2
BUAC ELEMENTARYY SCHOOL

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS

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

Name of Employee GRIT S. PANGAN Employee No. 4247498

Office BUAC ELEMENTARY SCHOOL
Division SOUTHERN LEYTE
Particulars Amount ( P )
TRAVEL FROM STATION TO CONSOLACION ELEMENTARY 40.00
SCHOOL AND VICE VERSA

TOTAL 40.00
Purpose:

I hereby certify that the above expenses are incurred as they are necessary for the aboved cited
purpose, that above goods and services were acquired from parties not issuing receipts. And that
I am fully aware that willful falsification of statement is punishable by law.
Certified correct: Noted by:
Signature
Printed Name GRIT S. PANGAN MELANIE A. TERANTE
Employee Immediate Supervisor
Date: Date