ANNEX A

WRIGHT NATIONAL HIGH SCHOOL

(Agency Name)
CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS
Pursuant to COA Circular No. 2017-001 dated June 19, 2017
Name of Employee MELODINA L. DACURO JRA. Employee No.
Office WRIGHT NHS
Division SDO-SAMAR
Particular Amount (P)
Meal for 1 participant (BREAKFAST/LUNCH/DINNER) 180
Snacks for 1 participant (AM/PM) 40
Fare
*Mugdo-Hinabangan 15
*Hinabangan-Mugdo 15
*Mugdo-Hinabangan 15
*Hinabangan-Mugdo 15
TOTAL 280
Purpose:
To attend the 2024 Division Schools Press Conference, Hinabangan Samar
I hereby certify 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 statement is punishable by law.
Certified correct: Noted by:
Signature
Printed Name MELODINA L. DACURO JRA. GERONIMA G. CEBLANO, PhD
Employee Immediate Supervisor
Date: April 13, 2024 Date:

ANNEX A

WRIGHT NATIONAL HIGH SCHOOL

(Agency Name)
CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS
Pursuant to COA Circular No. 2017-001 dated June 19, 2017
Name of Employee MELODINA L. DACURO JRA. Employee No.
Office WRIGHT NHS
Division SDO-SAMAR
Particular Amount (P)
Meal for 1 participant (BREAKFAST/LUNCH/DINNER) 180
Snacks for 1 participant (AM/PM) 40
Fare
*Mugdo-Hinabangan 15
*Hinabangan-Mugdo 15
*Mugdo-Hinabangan 15
*Hinabangan-Mugdo 15
TOTAL 280
Purpose:
To attend the 2024 Division Schools Press Conference, Hinabangan Samar.
I hereby certify 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 statement is punishable by law.
Certified correct: Noted by:
Signature
Printed Name MELODINA L. DACURO JRA. GERONIMA G. CEBLANO, PhD
Employee Immediate Supervisor
Date: April 13, 2024 Date: