Department of Education

Region VII – Central Visayas

Division of Cebu City DEPARTM EN T OF EDU CATION

Name of School:CEBU CITY NATIONAL SCIENCE HIGH SCHOOL

ANNEX A
CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS
Pursuant to COA Circular No. 2017-001- dated June 19, 2017
Name of Employee RANDOLF T. DEL MAR Employee No. 30314117
Office Cebu City National Science High School
Division Cebu City
Particulars Amount ((₱)
July 24,2023- Rice,Porkchop,Mango,Softdrinks 160.00
Siopao,Coffee,Water 99.00

July 25,2023- Rice,Fried chicken,Chopsuey,Softdrinks,Banana 140.00

Bread,Shake,Water 110.00

TOTAL 509.00
Purpose
Payment for MEAL Allowance incurred on July 24-25,2023

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 wilful falsification of statements is
punishable by law.
Certified Correct: Noted By:
Signature:
Printed Name: RANDOLF T. DEL MAR CHARLIE L. SALVE EdD
Employee School Head
Date 09/01/2023 Date 09/01/2023
 Department of Education
Region VII – Central Visayas
Division of Cebu City DEPARTM EN T OF EDU CATION

Name of School:CEBU CITY NATIONAL SCIENCE HIGH SCHOOL

ANNEX A
CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS
Pursuant to COA Circular No. 2017-001- dated June 19, 2017
Name of Employee IRISH A. CASILAO Employee No. 6074688
Office Cebu City National Science High School
Division Cebu City
Particulars Amount ((₱)
Fried Fish, Humba, Rice 120.00
Bread,Softdrinks,Coffee 139.00

TOTAL 259.00
Purpose
Payment for MEAL Allowance incurred on July 24,2023

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 wilful falsification of statements is
punishable by law.
Certified Correct: Noted By:
Signature:
Printed Name: IRISH A. CASILAO CHARLIE L. SALVE EdD
Employee School Head
Date 09/01/2023 Date 09/01/2023
 Department of Education
Region VII – Central Visayas
Division of Cebu City DEPARTM EN T OF EDU CATION

Name of School:CEBU CITY NATIONAL SCIENCE HIGH SCHOOL

ANNEX A
CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS
Pursuant to COA Circular No. 2017-001- dated June 19, 2017
Name of Employee LUCILA A. CUMAYAS Employee No. 30314105
Office Cebu City National Science High School
Division Cebu City
Particulars Amount ((₱)
Vegetables,Humba,Rice,Sofdrinks,Banana 125.00
Bread, Coffee, Water 125.00

TOTAL 250.00
Purpose
Payment for MEAL Allowance incurred on July 24,2023

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 wilful falsification of statements is
punishable by law.
Certified Correct: Noted By:
Signature:
Printed Name: LUCILA A. CUMAYAS CHARLIE L. SALVE EdD
Employee School Head
Date 09/01/2023 Date 09/01/2023
 Appendix 46 Appendix 46

REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPT

Entity Name: ________ Fund Cluster : ________ Entity Name: ________ Fund Cluster : ________
Date : __________________ RER No. : ______________ Date : __________________ RER No. : ______________
RECEIVED from CEBU CITY NATL SCIENCE HS RECEIVED from CEBU CITY NATL SCIENCE HS
(Name)
_________________________________________________ the (Name)
_________________________________________________ the
amount amount
(Official Designation) (Official Designation)
of _____________________ (P.00) of _____________________ (P.00)
in (In Words)
payment (in Figures)
for in (In Words)
payment (in Figures) for
_______________________________________________ _______________________________________________
(Payments for subsistence, services, (Payments for subsistence, services,
_______________________________ _______________________________
rental or transportation should show inclusive dates, rental or transportation should show inclusive dates,
_____________________________ _____________________________
purpose, distance, inclusive points of travel, etc.) purpose, distance, inclusive points of travel, etc.)
PAYEE PAYEE

Name/Signature: ____________________________ Name/Signature: ____________________________

Address: ____________________________ Address: ____________________________

WITNESS WITNESS
Name/Signature ________________________________________ Name/Signature __________________________________________
Address _______________________________________________ Address ________________________________________________

Appendix 46 Appendix 46

REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPT

Entity Name: ________ Fund Cluster : ________ Entity Name: ________ Fund Cluster : ________
Date : __________________ Date : __________________
RER No. : ______________ RER No. : ______________

RECEIVED from CEBU CITY NATL SCIENCE HS RECEIVED from CEBU CITY NATL SCIENCE HS
(Name)
_________________________________________________ the (Name)
_________________________________________________ the
amount amount
(Official Designation) (Official Designation)
of _____________________ (P.00) of _____________________ (P.00)
in (In Words)
payment (in Figures)
for in (In Words)
payment (in Figures) for
_______________________________________________ _______________________________________________
(Payments for subsistence, services, (Payments for subsistence, services,
_______________________________ _______________________________
rental or transportation should show inclusive dates, rental or transportation should show inclusive dates,
_____________________________ _____________________________
purpose, distance, inclusive points of travel, etc.) purpose, distance, inclusive points of travel, etc.)
PAYEE PAYEE
Name/Signature: ____________________________ Name/Signature: ____________________________
Address: ____________________________ Address: ____________________________

WITNESS WITNESS
Name/Signature ________________________________________ Name/Signature __________________________________________
Address _______________________________________________ Address ________________________________________________