Fund Cluster:

CENTRAL MINDANAO UNIVERSITY GF MOOE

Date:08/3/2022

DISBURSEMENT VOUCHER
DV No. :

Mode of MDS Check

Commercial Check
ADA Others (Please specify)
Payment
TIN/Employee No.: ORS/BURS No.:
Payee TERESITA F. PEPITO

Address Musuan, Maramag, Bukidnon

Particulars Responsibility Center MFO/PAP Amount

To reimburse payment per diem of travel to conduct PHP 2,740.00

monitoring BSOA Student internship
last May 26-27 of the amount of . . . . . . .

Attached:

Approved Communication Letter

Travel Order
Itinerary of travel
Certificate of Appearance
Travel Completed
Receipt

Amount Due PHP 2,740.00

A. Certified: Expenses/Cash Advance necessary, lawful, and incurred under my direct supervision.

DARYL JANE A. CABALLERO

DEAN, COLLEGE OF BUSINESS AND MANAGEMENT

B. Accounting Entry:
Account Title UACS Code Debit Credit

C. Certified: D. Approved for Payment

Cash available

Subject to Authority to Debit Account (when applicable)

Supporting documents complete and amount claimed

proper

Signature Signature
Printed
Name
MARIA JAMELLAH CELESTE M. MAGALONA Printed Name JESUS ANTONIO G. DERIJE
Chief, Accounting Unit SUC-President IV
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Check/ Date : Bank Name & Account Number:
ADA No. :
Date : Printed Name: Date
Signature :
Official Receipt No. & Date/Other Documents
 ITINERARY OF TRAVEL

Entity Name : Central Mindanao University

Fund Cluster : No.: ______________
Name : Date of Travel :
Position : Purpose of Travel :
Official Station :

Places to be visited TIME Means of Transport- Per Total

Date Others
(Destination) Departure Arrival Transportation ation Diem Amount

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

TOTAL - - - -
Prepared by :

I certify that : (1) I have reviewed the foregoing

itinerary, (2) the travel is necessary to the
service, (3) the period covered is reasonable and Official Employee
(4) the expenses claimed are proper.
Approved by:

CHARLIE A. MUNDAL JESUS ANTONIO G. DERIJE

Chief, Budget Office President

By the Autority of the President:

JOSE ALEXANDER C. ABELLA

Vice-President for Academic Affairs
 CERTIFICATION OF TRAVEL COMPLETED

Entity Name: Central Mindanao University Fund Cluster: GF MOOE

JESUS ANTONIO G. DERIJE CMU, Musuan, Bukidnon

University President Station

I HEREBY CERTIFY THAT I have completed the travel as authorized in the Travel
Order/Itinerary of Travel No. ___________dated June 26-july 2, 2022 under conditions indicated below:

/ / Strictly in accordance with the approved itinerary.

/ / Cut short as explained below. Excess payment in the amount of
P__________ was refunded under O.R. No. _________dated ___________
/ / Extended as explained below, additional itinerary was submitted
/ / Other deviation as explained below.

Explanation or justifications:

Evidence of travel:
Certificate of Apperance, Travel Order, Itinerary of travel

Respectfully submitted:

NEREE MAE S. ESTANO

On evidence and information of which I have the knowledge, the travel was actually
undertaken.

Approved:

DARYL JANE A. CABALLERO

DEAN, CBM
 PAYROLL
For the period _______________

Entity Name : ______________________________ Payroll No. : ________________

Fund Cluster : _____________________________ Sheet _______of _______Sheets
We acknowledge receipt of cash shown opposite our name as full compensation for services rendered for the period covered.

COMPENSATIONS DEDUCTIONS
Serial Employee Salaries and Net Amount
Name Position Gross Amount Total Signature of Recipient
No. No. Wages- Due
Earned Deductions
Regular

A CERTIFIED: Services duly rendered as stated. C APPROVED FOR PAYMENT: _________________________________________________

____________________________________________________________ (P

Signature over Printed Name of Authorized Date (Signature over Printed Name) Date
Official Head of Agency/Authorized
Representative

B CERTIFIED: Supporting documents complete and proper; and cash available D CERTIFIED: Each employee whose name appears on the E
in the amount of P _______________. payroll has been paid the amount as indicated opposite his/
her name ORS/BURS No. : _________
Date : _________________
JEV No. : ______________
(Signature over Printed Name) Date (Signature over Printed Name) Date : _________________
Head of Accounting Division/Unit Disbursing Officer
 PURCHASE REQUEST
Entity Name: CENTRAL MINDANAO UNIVERSITY Fund Cluster: SDF
Office/Section : Budget PR No.: ___________________________ Date: 1/25/2024
Responsibility Center Code : __________________

Stock/Property
Unit Item Description Quantity Unit Cost Total Cost
No.
MOOE- Semi Expandable Machinery & Equipment Expenses

unit Manual Steno Machine with paper notes 5 6,000 30,000

Manual Typewriter
6 15,000 90,000

Total 120,000.00
Purpose: For Office Use

Requested by: Approved by:

Signature :
Printed Name : DARYL JANE A. CABALLERO ROLITO G. EBALLE
Designation : Dean, CBM UNIVERSITY PRESIDENT
 PURCHASE REQUEST
Entity Name: CENTRAL MINDANAO UNIVERSITY Fund Cluster: _____________________
Office/Section : Budget PR No.: ___________________________ Date: November 13, 2019
Responsibility Center Code : __________________

Stock/Property
Unit Item Description Quantity Unit Cost Total Cost
No.

Total -
Purpose: For Budget Office use

Requested by: Approved by:

Signature :
Printed Name : CHARLIE A. MUNDAL JESUS ANTONIO G. DERIJE
Designation : Chief, Budget Office President
 LIQUIDATION REPORT Serial No.: ___________________
Period Covered September 27-30, 2016 Date: October 3, 2016

Entity Name : CENTRAL MINDANAO UNIVERSITY Responsibility Center Code:

Fund Cluster : 01 ___________________________

PARTICULARS AMOUNT

To liquidate the cash advance while on official travel to

House of Representatives, Quezon City, Metro Manila
on September 27-30, 2016 to attend the Pre-Plenary
and Plenary FY 2017 Budget Hearing in the amount of ….. 3,520.00

TOTAL AMOUNT SPENT 4,120.00

AMOUNT OF CASH ADVANCE PER DV NO. _________DTD.__________ 3,520.00
AMOUNT REFUNDED PER OR NO.______________DTD.___________ -
AMOUNT TO BE REIMBURSED 600.00
A Certified: Correctness of the B Certified: Purpose of travel/cash C Certified: Supporting
above date advance duly accomplished documents complete and proper

EDWIN A. MENDOZA BOBBY D. VISAYAN VIOLETO D. AYUBAN

Signature over Printed Name Signature over Printed Name Signature over Printed Name
Claimant Immediate Supervisor Head, Accounting Division Unit

JEV No.: ___________________

Date: ________________________ Date: ______________________ Date: ____________________
 REIMBURSEMENT EXPENSE RECEIPT
Entity Name: _______________ Fund Cluster : ______
Date: _____________________ RER No. : ___________
RECEIVED from _______________________________
(Name)
___________________________________ the amount
(Offical Designation)
of _______________________________ (P _________)
(In Words) (In Figures)
in payment for ___________________________________
(Payments for subsistence, services,
rental or transportation should show inclusive dates,
purpose, distance, inclusive points of travel, etc.)
PAYEE
Name/Signature ________________________________
Address ______________________________________
WITNESS
Name/Signature ________________________________
Address ______________________________________
REIMBURSEMENT EXPENSE RECEIPT
Entity Name: _______________ Fund Cluster : ______
Date: _____________________ RER No. : ___________
RECEIVED from _______________________________
(Name)
___________________________________ the amount
(Offical Designation)
of _______________________________ (P _________)
(In Words) (In Figures)
in payment for ___________________________________
(Payments for subsistence, services,
rental or transportation should show inclusive dates,
purpose, distance, inclusive points of travel, etc.)
PAYEE
Name/Signature ________________________________
Address ______________________________________
WITNESS
Name/Signature ________________________________
Address ______________________________________
REIMBURSEMENT EXPENSE RECEIPT
Entity Name: _______________ Fund Cluster : ______
Date: _____________________ RER No. : ___________
RECEIVED from _______________________________
(Name)
___________________________________ the amount
(Offical Designation)
of _______________________________ (P _________)
(In Words) (In Figures)
in payment for ___________________________________
(Payments for subsistence, services,
rental or transportation should show inclusive dates,
purpose, distance, inclusive points of travel, etc.)
PAYEE
Name/Signature ________________________________
Address ______________________________________
WITNESS
Name/Signature ________________________________
Address ______________________________________
REIMBURSEMENT EXPENSE RECEIPT
Entity Name: _______________ Fund Cluster : ______
Date: _____________________ RER No. : ___________
RECEIVED from _______________________________
(Name)
___________________________________ the amount
(Offical Designation)
of _______________________________ (P _________)
(In Words) (In Figures)
in payment for ___________________________________
(Payments for subsistence, services,
rental or transportation should show inclusive dates,
purpose, distance, inclusive points of travel, etc.)
PAYEE
Name/Signature ________________________________
Address ______________________________________
WITNESS
Name/Signature ________________________________
Address ______________________________________
 PETTY CASH VOUCHER
Entity Name: _____________________________
Fund Cluster: ____________________________
Payee/Office : ___________________________
Address : _________________________
I. To be filled out upon request
Particulars
A Requested by:
(signature over printed name)
Requestor
Approved by:
(signature over printed name)
Immediate Supervisor
B Paid by:
(signature over printed name)
Petty Cash Custodian
Cash Received by:
(signature over printed name)
Payee
Date: ______________
PETTY CASH VOUCHER
Entity Name: _____________________________
Fund Cluster: ____________________________
Payee/Office : ___________________________
Address : _________________________
I. To be filled out upon request
Particulars
A Requested by:
(signature over printed name)
Requestor
Approved by:
(signature over printed name)
Immediate Supervisor
B Paid by:
(signature over printed name)
Petty Cash Custodian
Cash Received by:
(signature over printed name)
No. : ________________
Date : _________________
Responsibility Center Code:
_____________________
II. To be filled out upon liquidation
Amount
Total Amount Granted _____________
Total Amount Paid per
OR/Invoice No. _____ ___________
Amount Refunded/
(Reimbursed) _____________
C
Received Refund
Reimbursement Paid
(signature over printed name)
Petty Cash Custodian
D
Liquidation submitted
Reimbursement Received by:
(signature over printed name)
Payee
Date: ______________
No. : ________________
Date : _________________
Responsibility Center Code:
_____________________
II. To be filled out upon liquidation
Amount
Total Amount Granted _____________
Total Amount Paid per
OR/Invoice No. _____ ___________
Amount Refunded/
(Reimbursed) _____________
C
Received Refund
Reimbursement Paid
(signature over printed name)
Petty Cash Custodian
D
Liquidation submitted
Reimbursement Received by:
(signature over printed name)
 Payee Payee
Date: ______________ Date: ______________
 BUDGET UTILIZATION REQUEST AND STATUS Serial No. :
Central Mindanao University Date :
Fund :

Payee CEMPRON, DARYL NIKO L. et. Al.

Office
Address Valencia City
UACS Object
Responsibility Center Particulars MFO/PAP Code/ Amount
Expenditures

Budget Office To obligate payment of plane tickets of Charlie A. Mund 19,223.20

and Jed Rex M. Timtim while on official travel to Manila
on October 10-12, 2016 attending the Senate FY 2017
Budget Hearing

Total 19,223.20
A. Certified: Charges to budget necessary, lawful B. Certified: Budget available and utilized
and under my direct supervision; and supporting for the purpose/adjustment necessary as
documents valid, proper and legal indicated above

Signature : Signature :
Printed Name : IRIS M. DAJAO-OPISO Printed Name : CHARLIE A. MUNDAL
Position : OIC-FMO Position : Chief, Budget Unit
Head, Budget Division/Unit/Authorized
Head, Requesting Office/Authorized Representative
Representative

Date : Date :

C. STATUS OF UTILIZATION
Reference Amount
Balance
BURS/JEV/RCI/ Due and
Date Particulars Utilization Payable Payment Not Yet Due
RADAI/RTRAI No. Demandable
(a) (b) ( c) (a-b) (b-c)

Utilization 19,223.20
 BUDGET UTILIZATION REQUEST AND STATUS Serial No. :
Central Mindanao University Date:June 8, 2021
Fund :

Payee DARYL JANE A. CABALLERO

Office College of Business and Management
Address Musuan, Maramag, Buidnon
UACS
Object
Responsibility Center Particulars MFO/PAP Code/ Amount
Expenditure
s

To obligate reimbursement of payment of participation

for virtual research presenation in the
College of Business and
Management 3rd International Conference on Advanced Research in 9,385.64
Social Sciences at Oxford,
United Kingdom last March 11-14, 2021 of the amount
of . . . . . . .

Total 9,385.64
A. Certified: Charges to budget necessary, lawful B. Certified: Budget available and
utilized
and under my direct supervision; and supporting for the purpose/adjustment necessary as
documents valid, proper and legal indicated above

Signature : Signature :
Printed Name : JOSE ALEXANDER C. ABELLA Printed Name : CHARLIE A. MUNDAL

Position : Vice President for Academic Affairs Position : Chief, Budget Unit

Head, Budget Division/Unit/Authorized

Head, Requesting Office/Authorized Representative
Representative

Date : Date :

C. STATUS OF UTILIZATION
Reference Amount
Balance
BURS/JEV/RCI/RADAI/ Due and
Date Particulars Utilization Payable Payment Not Yet Due
RTRAI No. Demandable
(a) (b) ( c) (a-b) (b-c)

Utilization 9,385.64
 Central Mindanao University
(Agency Name)

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS

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

Name of Employee Employee No.

NEREE MAE ESTANO

Office COLLEGE OF BUSINESS AND MANAGEMENT

Division

Particulars Amount (P)

NAIA to Hotel (taxi) 300.00

Hotel to NAIA (taxi) 300.00

TOTAL 600.00

Purpose

Attending SUCFAIR 2022 at MOA, Pasay City

I hereby certify that the above expenses are incurred as they are necessry 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 DARYL JANE A. CABALLERO JOSE ALEXANDER C. ABELLA
CBM, DEAN VP for ACADEMIC AFFAIRS
Date Date
 OBLIGATION REQUEST AND STATUS Serial No. :
Central Mindanao University Date : 03/08/2022
Fund : GF MOOE

Payee TERESITA F. PEPITO

Office CENTRAL MINDANAO UNIVERSITY
Address MUSUAN, MARAMAG, BUKIDNON
UACS Object
Responsibility Center Particulars MFO/PAP Amount
Code

To obligate reimbursement payment per diem

of travel to conduct monitoring BSOA Student 2,740.00
internship last May 26-27 of the amount of . . . . . . .

Total 2,740.00
A. Certified: Charges to appropriation/allotment are B. Certified: Allotment available and ob-gated
necessary, lawful and under my direct supervision; and for the purpose/adjustment necessary as
supporting documents valid, proper and legal indicated above

Signature : Signature :
Printed Name : DARYL JANE A. CABALLERO Printed Name : CHARLIE A. MUNDAL
Position : DEAN, CBM Position : Chief, Budget Unit
Head, Budget Division/Unit/Authorized
Head, Requesting Office/Authorized Representative
Representative

Date : Date :

C. STATUS OF OBLIGATION
Reference Amount
Balance
ORS/JEV/Check/ADA/ Due and
Date Particulars Utilization Payable Payment Not Yet Due
TRA No. Demandable
(a) (b) ( c) (a-b) (b-c)

Obligation 2,740.00
 02-101101-2018-12-2750

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