DEPED – DIVISION OF SAMAR DEPED – DIVISION OF SAMAR

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS
Pursuant To COA Circular No. 2017-008 Dated Juneb 19, 2017
Pursuant To COA Circular No. 2017-008 Dated Juneb 19, 2017
Name of Employee Employee No.
Name of Employee Employee No.

Office
Office
Division
Division
Particulars Amount (P)
Particulars Amount (P)

TOTAL
TOTAL

Purpose Purpose

I hereby certify that the above expenses are incurred as they are I hereby certify that the above expenses are incurred as they are
necessary for the above DEPEDcited purpose,
– DIVISION OF SAMARthat above, goods and necessary for the above cited purpose,
DEPED that
– DIVISION OF above,
SAMAR goods and services
services were acquired from the parties not issuing receipts, and that were acquired from the parties not issuing receipts, and that I am fully
I am fully aware that willful OF
CERTIFICATION falsification
EXPENSES NOT of statements
REQUIRING RECEIPTSis punishable by aware that willful falsification
CERTIFICATIONofOFstatements
EXPENSES NOTis punishable by law.
REQUIRING RECEIPTS
law. Pursuant To COA Circular No. 2017-008 Dated Juneb 19, 2017 Pursuant To COA Circular No. 2017-008 Dated Juneb 19, 2017
Certified Correct: Noted
Name of Employee Certified Correct:Employee No. Noted Name of Employee Employee No.

Signature
Signature
Office Office
Employee Immediate Supervisor
Division Employee Immediate Supervisor Division

Particulars Amount (P) Date:Particulars Date: Amount (P)

Date: Date:

TOTAL TOTAL

Purpose Purpose

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

Certified Correct: Noted Certified Correct: Noted

Signature Signature
Employee Immediate Supervisor Employee Immediate Supervisor
Date: Date: Date: Date: