ACCO<JNTNo. ACCOUNT.._ CHECK No.

llltlTJrl
004012-1018-43 DEPED JAIME L GAMILLA ELEMENTARY 0000252351 1303f
SCHOOL 11111111111111111 IIII IIII 01113
351 1),3-f{g-a,c,rt.B
"Member: PDIC"
DATE •." ._" 0 - ,- , · , _, _ , -
PAY TO THE
ORDER OF 1... A /11,tJ f;'((T J12.P.:.P 1NG p

PESOS f b..,. 11.ow.Ctll\4 j=;jl] bi' H Pt.-.to.5 :28 J,,r, O,vf7

f ILJ allow the electronic dearing of this check and hereby waive the presentation for payment of rhis original to LANDBANK.

O~!~~~ANK BRGY. SINGAI.AT, PALAYAN CITY

NUEVAECIJA

2s 23 s ,n•, 3 ,a 3,:ooi..o, 2 rn mi.. 311• ooo

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J.i MAR 16 lllll
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V
 Department of Education
Region m
Division of Nueva Ecija
Disbict ofBongaboo
JAIME L, GAMILLA ELEMENTARY SCHOOL
Fund Cluster : 0 I
Dale: O~•)l,• P.~
DISBURSEMENT voucrnER
DVNo.: ~o~'lJ-6,- )1

Mode or
0MDsCheck Ocommcn:ial Check 0Othcn (Please specify)
Payment

Payee !TIN/Employee No.: ORS/BURS No.:

LAMBERT TRADING ,, ?o _ g ~'f- d""J7 -ooo
TALA ...KA , 1' Ut.. A L~--~
AddreH

Particula1> Responsibility Center MFO/PAP Amount

LAMBERT TRADING, Payment for the

purchase of First Aid Kit (DRRM Fund)

GROSS AMOUNT p 4,288.00

229.72

TAX WITHHELD
VAT 5% 191.43
1% 38.29
AmoantDlle 229.72 p 4,058.28
Certified: Expmses/Cash Advance necessary, lawful and inCUITed under my ~upe,vision .
.'l't'[
PAMELA G. ORDUELA
School Principal

B. I Acwunting Entry:
Account Title UACSCode Debit Credit
OFFICE SUPPLIES EXPENSES 5020301000 4,288.00
DUE TO BIR 229.72
ADVANCE FOR OPERATING EXPENSES 199010400 4,058.28
c. lCertlfied: D. IApproved for Payment
LJ Cash available
D Subject to Authority to l>ebit Account (when applicable)
FOUR TIIOUSAND FIF1Y EJGIIT PESOS AND 28/100 ONLY
D Supporting documents complete and amount claimed
proper

Signature Si!lllature
-fl,~,,_./
Printed
Printed Name u
Name ~ELLRNATALIO PAMELA G. JORDUELA
Position School Treasurer Position School Principal

Date Date

E. !Receipt of Payment JEV No.

Check/ PS' 1. '? s'- Date: -J Bank Name & Account Number:
ADA No.: r) 01-/1,-~ot
Signature:
i
Official ReceiJ!(" No. & Date/Other Documents
Date 'IJ'J/, ,~, 1.rf, Printed Name: LAMBERT TRADING Date

~£TI~
Jj MAR 1 6 2023 J)
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 ·invoice No.
•
In settlement of the following:
Amount
LAMBERT TRADING
e
(Beside Talavera Petls), Maan District (Pob.),
3114 Talavera, ~Ecija
LORAINE A. MALUBNJ .• iProprletnlsa
VAT Reg. TIN: 22 ~2-00000

ICOLLECTION RECEIPT,
f~ - i4962 ·
o~-fl,- ~,.~
-.a -
end eddrass et
with TIN
::- £ ~),j,
t.p &!H- 7
D

engaged In the bus~ style of

the sum of
a~
Form of Payment In partial/full payment for fJr,t
Cash D Check D
•-~11Tll•1GII
~:.-.:rc:=:tW·m:umnemnrt
~l'WTO.-'Tllllo.:- llt11791MII
NOM-YAT~11t.11N2M1-
117 ...... III. ...... ._C&Clr

. . - ·c • •• ~-. - .•. . . • . [AMSERf.tRADING" ..-.--.......... -- ... -

(Beside Talavera Patis), Marcos District (Pob.), 3114 Talavera, Nueva Ecija .
LORAINE A. MALUBAG • Proprietress
VAT Reg, TIN: 220-834-592-00000
·1 SALES INVOICE I N~ 1~250
Sold to: ,¼I~ ~- 6'rfy,~6
Address: '.t}"'!Pb...-, \,'
Terms:._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ TIN: 5'70-818- 7'.?'j- ~:?'J
OSCNPWD ID No..:_ _ _ _ _ _ _ _ _ _ _ _ _ Cardholder's Signature: _ _ _ __
Business Styles·
Qty: Unit ARTICLES Unit Price Amount
io '3:R . - -- . [)O(WjA/ UO. Uki
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q !7 \.~ Ul½tun u'l m1.
to '?J Go-vtt ~,-,Jc.,,.• \Dl. 'lt~
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Cf"l}L,"7_'--.LI.. 1 n , Total Sales (VAT Inclusive) (.l,')_}('l
I\ II Less: VAT
· VATabla Sales J( UAD 1 l; 11111 IJ Amount Net of VAT
VAT-&emptSaies - - Less: SCtPWD Discount
Zero Rated Sales -1' t " " ~

~--,·--
, Amount Due
VAT Amount Add:VAT
Q;f TOTAl AMOUNT DUE P \.f l, Ni.
Ftl>nliryU,2011

. 9
100Blla.(9112)1115MmG
t1t\?) =-=:.:::1.¥f"UZ1RZMlUPZP
.-eal'WTO.PRESS•TaNo,_ I01117-71
NOM-YATRlt- 11N:17N2M1._
.,, ...., Ed.,Slllgl!M EMl,C&Clly Cashier/Authorized Representative
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l&.epnrtuumt of Gfblwttion
REGION 111- CENTRAL LUZON
SCHOOLS DIVISION OFFICE OF NUEVA BCIIA
JAIME L. GAMILLA BLEMBNTARY SCHOOL
BRGY. DIGMALA. BONGABON, NUBVA ECIJA 3128

DRRM SUPPLIES FOR MONTH OF MARCH

~
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I

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1j MAR 1 6 2023 LJ
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.lupu&Ut of l'!)c •bilipptnd
JB.qmrtuttnt of ebamtion
REGION Ill - CENTRAL LUZON
SCHOOLS DIVISION OFFICE OP NUEVA l!CJA
JAIME L GAMILLA l!Ll!Ml!NTARY SCHOOL
BRGY. DIGMALA, BONGABON, NUl!VA l!CIJA 3128

DRRM SUPPLIES FOR MONTH OF MARCH

 •
PURCHASE REQUEST

En tity Name: Dtj!artment o£Ed ucation Fund Cluster· 6I

1),:P- ~,- - ':(O')._?
Office/Section : PR No.: 2023 - 6?/ · 01 Date:
JAIME L GAMlLLA Responsibility Center Code :
ELEMENTARY SCHOOL
Stock/ Qty Unit Cost Total Cost
Unit Item Description
Property No.
1 10 48 480
BOTTLES HYDROGEN PEROXIDE
2 10 167 1670
BOTTLES BETADINE
3 PCS 9 48 432
COTTON
4 PCS GAUZE BANDAGE 10 66 660
s PCS MEDICAL TAPE 10 57 570
6 BOX BAND AID 1 301 301
7 PACK 1 175 175
BIOGESIC

TOTAL 4288

f t'tl },citti ((,,'f 4-r Y¥-'/ZrP"' Li'di-.o/ C{t-e

Requested by: Approved by:

Signature: -tt-ftv
Printed Name MARY ANN P. REYES PAMELA G. JORDUELA
Designation : PROPERTY CUSTODIAN SCHOOL PRINCIPAL

fr>£TI~
Ji MAR 1 6 2023 Jj
-rtvcr:::
 Department of Education
"'( RegionJll
'
(ii) Schools Oivision ot' Nueva Ecija
District ofBongabon EDVKASVO~
:r~C>
JAIME L. GAMILLA ELEMENTARY SCHOOL
ABSTRACT OF CANVASS BID
FOR THE PURCHASE OF FIRST AID KIT(DRRM FUND)
01::J.UUll V f VJ ~v-.. .

LAMBERT TRADING THREE KINGS MEL&JESS

QTY UNIT ARTICLES
UNIT PRICE TOTAL UNIT PRICE TOTAL UNIT PRICE TOTAL
lU R,Utllt-"'i MTUJ<Ul>~N PEROXIUt 41l 480 53 530 58 580
10 BOTTLES BETADINE 167 1670 172 1720 177 1770
9 PCS COTTON 48 432 53 477 58 522 0
10 PCS GAUZE BANDAGE 66 660 71 710 76 760
10 PCS MEDICAL TAPE 57 570 62 620 67 670
1 BOX BAND AID 301 301 306 306 311 311
1 PACK BIOGESIC 175 175 180 180 185 185

1urAL 4288 4543 4798

Kecommendmg award to • M,v, INl,

Prices considered just and reasonable and does not exceed the prices prevailing in the locality.

~£il'f\\ MARY ~ Y E S PAME21'~ UEL A

School Property Custodian SCHOOL PRINCIPAL
J.i MAR 1 6 2023 1J
'lC''J:::!_ •
 0 Department of Education
Region ll1
Schools Division ofNueva Ecija
District or Bongabon
JAIME L, GAMILLA ELEMENTARY SCHOOL
REQUEST FOR QUOTATION
Date: r>,-b"l- e:?n3>
Quotation Reference Number: --'~"-o_l....;..~_-.....::;~..1.?:.._-_0::...,.7_ __
Sir/Madam :

Please quote your lowest price on the ltem/s listed below, stating the shortest time of delivery and submit your
i) ,'('fr~
CRISTAL LEf'D, LEOPANDO PAMELA GAORDUELA
Canvasser School Principal
PROCUREMENT TERMS ANO CONDITIONS
1. The Approved Budget for the Contract Is PhP 11
2 &{s · ti<>
2. Price quoted are subject to deduction of 5% VAT & 1% EWT (for goods) or 5%VAT & 2%EWT (for services)
3. Goods, supplies, equipment or work done are subject to Inspection/acceptance, OepEO reserves the right to cancel
reject or rebid the Items which do not conform with the specifications.
4. Complete technical specifications, brand & model must be indicated in the price quotation for evaluation purposes.
5. Delivery period shall be Indicated in the quotation. A liquidated damages equivalent to 1/10 of 1% per day
of delay for the value of undelivered Items shall be Imposed.
6. All bids In excess of the ABC will be rejected.
7. Supplier warrants that he/she has not given nor promised to give any money or gift to any DepEd employee to
secure this offer and to obtain an award.

Item No. Quantltv Unit Item and Descrlotlon Unit Price Total Amount
1
2
3
10
10
9
BOffiES
BOffiES
PCS
HYDROGEN PEROXIDE
BETADINE
COTTON
,.~
ITT

'Le
lln~
Ii;,-,
4 10 PCS GAUZE BANDAGE
,;, • '.t.11\
5 10 PCS MEDICAL TAPE 1:(-:1 ~ )

6
7
1
1
BOX
PACK
BAND AID
BIOGESIC "'""' ,~
3vl

.
TOTAL U,Tl2'.'i!"

Delivery Period : Within Seven (7) Calendar Days upon Supplier's reciept ot Purchase order.
Warranty : Warranty shall be for a period of Six (6) Months for Supplies & Materials,
One (1) Year for Equepment from Date of Acceptance by the Procuring Entity.
Price Validity : Price should be valid thirty (30) calendar days after the deadline of submission of quatation.
Delivery Term : Seven(7) Days.
Payment Term : Fifteen(lS) Days.
After having carefully read and accept your Procurement Terms & Conditions, I/We quot
noted above.

c(f) £ U~\ Designation:....l!.l41~~~L\-.\J\:~J.d£_ _ _ __

Company Name:

Jj MAR 1 2.iWLll J) Business Address:~&;;!.Jq,Y,.-i:l:illl~,g....-------

Telephone Number/CP number: ~.:.W'-2.:!:l!i:l,!,..:::ls.::J..:U.-------
Email Address:

-tr_tfd:- --------------
 C, e
•
• Department of Education
Region llJ _,_ ~ -Y-
..
.
Schools Division ofNueva Ecija :A
tA
~TC>
6.DUKASV0'1zg
District of Bongnbon
JA™E L GAMILLA ELEMENTARY SCHOOL
REQUEST FOR QUOTATION
Date :
Quotation Reference Number: :{4 :t. '7 - o -o7
Sir/Madam:

Please quote your lowest price on the ltem/s listed below, stating the shortest time of delivery and submit your
-rt-~,......
PAMELA (i/JORDUELA
School Principal
PROCUREMENTTERMS AND CONDITIONS
1. The Approved Budget for the Contract Is PhP 1,
:i,iJ,5 · /10
2. Price quoted are subject to deduction of 5% VAT & 1% EWT (for goods) or 5%VAT & 2%EWT (for services)
3. Goods, supplies, equipment or work done are subject to inspection/acceptance, DepED reserves the right to cancel
reject or rebid the Items which do not conform with the specifications.
4. Complete technical specifications, brand & model must be indicated in the price quotation for evaluation purposes.
5. Delivery period shall be indicated in the quotation. A liquidated damages equivalent to 1/10 of 1% per day
of delay for the value of undelivered items shall be imposed.
6. All bids in excess of the ABC will be rejected.
7. Supplier warrants that he/she has not given nor promised to give any money or gift to any OepEd employee to
secure this offer and to obtain an award.

Item No. Quantitv Unit Item and Descrlntlon Unit Price Total Amount
1 10 BOffiES HYDROGEN PEROXIDE I _;L 1?04\
2 10 BOffiES BETADINE f:i,") ~r:..rJ-r\
3 9 PCS COTTON 11.,
LPn
4 10 PCS GAUZE BANDAGE -17] ---tlv
s 10 PCS MEDICAL TAPE I J ( ll 11\
6 1 BOX BAND AID , ,, ~ I\ ~f"iln
7 1 PACK BIOGESIC ha \ / 'k-9 )
-
TOTAL I L 1/, :>,

: Within Seven (7) Calendar Days upon Supplier's reciept ot Purchase order.
'
Delivery Period
Warranty : Warranty shall be for a period of Six (6) Months for Supplies & Materials,
One (1) Year for Equepment from Date of Acceptance by the Procuring Entity.
Price Validity Price should be valid thirty (30) calendar days after the deadline of submission of quatation.
Delivery Tenn : Seven(7) Days.
Payment Tenn : Fifteen(lS) Days.
After having carefully read and accept your Procurement Terms & Conditions, 1/W quote n t e item at prices
noted above.

fF)£TI~ Designation;.:~;,...i..~:.......J6',-,!---,--------
Company Name.--!-!i::,:<C..,....-,....,-L..~,...ll;:d--------
Business Address:_~:q.,--,l'=;.,-1,h,;.:c...,....;~L+.=----
l_i MAR 1 6 2023 J) Telephone Number/CP number: _.:=:.i...::=~~~µ::.=-~c..:..----

~er Email Address: _ _ _ _ _ _ _ _ _ _ _ _ _ __

 ()
Department of Education
e
Region III
Schools Division ofNueva Ecija
- ~-i.::
:C~Te>
EDVKASVC>NC
District or Boogabon
JAIME L, GAMILLA ELEMENTARY SCHOOL
REQUEST FOR QUOTATION
Date:
Quotation Reference Number: 306 tJ 0 '7
Sir/Madam:

Please quote your lowest price on the ltem/s listed below, stating the shortest time of delivery and submit your

CRISTAL 5D. LEOPANOO

~asser
PAM~~UELA
School Principal
PROCUREMENT TERMS AND CONDITIONS
1. The Approved Budget for the Contract Is PhP ...;:.~,4...:2.~g..,,g:'--''-'v-J:....:.._ _ __
2. Price quoted are subject to deduction of 5% VAT& 1% EWT (for goods) or 5%VAT & 2%EWT (for services)
3. Goods, supplies, equipment or work done are subject to inspection/acceptance, DepED reserves the right to cancel
reject or rebid the Items which do not conform with the specifications.
4. Complete technical specifications, brand & model must be indicated In the price quotation for evaluation purposes.
5. Delivery period shall be indicated in the quotation. A liquidated damages equivalent to 1/10 of 1% per day
of delay for the value of undelivered Items shall be imposed.
6. All bids in excess of the ABC will be rejected.
7. Supplier warrants that he/she has not given nor promised to give any money or gift to any DepEd employee to
secure this offer and to obtain an award.

Item No. Quantltv Unit Item and Descrlotlon Unit Price Total Amount
1 10 BOffiES HYDROGEN PEROXIDE
2 10 BOffiES BETADINE /7]-
3 COTTON (T-1-" ~.,?,2,
9 PCS
4 10 PCS GAUZE BANDAGE -9f :::).&;i,
s 10 PCS MEDICAL TAPE t/7 1P~
6 1 BOX BAND AID ? / 317
7 1 PACK BIOGESIC /-Cli /A'r-

TOTAL <-;/

Delivery Period : Within Seven (7) Calendar Days upon Supplier's reciept ot Purchase order.
Warranty : Warranty shall be for a period of Six (6) Months for Supplies & Materials,
One (1) Year for Equepment from Date of Acceptance by the Procuring Entity.
Price Validity : Price should be valid thirty (30) calendar days after the deadline of submission of quatation.
Delivery Term : Seven(7) Days.
Payment Term : Fifteen(lS) Days.
After having carefully read and accept your Procurement Terms & Conditions, I/We quote yo on he item at prices
noted above. '

ATURE
Designati

~ £TI~ Company Name:

Business Address: ' =
1_i MAR 1 6 liJ?J lJ Telephone Number/CP number:
Email Address:
---------------
·~=('7

-ft'~
 Department of Education
Region Ill
Schools Division ofNueva Ecija
I~,c,
- - ~ ..i.::
li DVKAS VC>'1:n

Dislrict ofBongahon
JAJME L GAMJLLA ELEMENTARY scuooL

PURCHASE ORDER
P.O.No. : ;J._o'J. ?; - 0 "? b7
Supplier : _ _ LAMBERT TRADING
TALAVERA NUEVA ECUA Date : , ':3 - oq- tzo?J
Address:
TIN: 220-834-592-000
ModeofProcurcmenl :-lJmA I! 1/...fwt. 0-~ "4
Gentlemen:
Please furnish this Office the following articles subject to the terms ond conditions contained herein:
U f1t, 1,Vt .t,jt.
~ ,.., 1., , ,~ ,u,..'.1.-t r_. Delivery Term :
Place of Delivery : 1}rm
Date of Delivery : 09/ - /Ir :i,o? 'l' Payment Term : ~-1.
Stock/ Property Quantity Unit Cost Amount
Unit Description
No. 480
HYDROGEN PEROXIDE 10 48
1 BOffiES
10 167 1670
2 BOmES BETADINE
9 48 432
3 PCS COTTON
10 66 660
4 PCS GAUZE BANDAGE
10 57 570
s PCS MEDICAL TAPE
3D1 ,n1
BOX BAND AID 1
6
1 175 175
7 PACK BIOGESIC

TOTAL 4288
rtotal amount In words' FOUR THOUSAND lWO HUNDRED EIGHlY EIGHT PESOS ONLY
In case of failure to make the full delivery within the time specified above, a penalty of one-tenth (1/10) of one percent for every
day of delay shall be imposed on the undelivered item/s.

Conforme: Vcry truly yours,

IAMB./J.ixADrnG
Signature over · ted Name of Supplier
PAMEL~UELA
Signature over Printed Name of School Principalffeacher
in Charge
o~- O"/· 2-,b~ SCHOOL PRINCIPAL
Date Designation

Fund Cluster : 6( ORS/BURS No. :

Date of the ORS/BURS:
Funds Available : ~i.;..-
E==fil,LR.NATALIO Amount: 1
2,gg . A\
I
Signature over Pnnted Name of School Treasurer

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jj MAR 1 6 2023 )J
_ 'fer -
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l\e.publit of tlJr t)1Jili1111int11
C
i!lepartment of Qfbucation
REGION Ill
SCHOOLS DMSION OFFICE OF NUEVA ECDA

RESOLUTION NO. 050, s. 2022

RESOLUTION OF THE OFFICERS AND MEMBERS OF THE SIDS AND AWARDS COMMITTEE
(BAC) OF DEP-ED, DIVISION OF NUEVA ECIJA RECOMMENDING THE NEGOTIATED
PROCUREMENT OF FIRST AID KIT FOR DRRM SUPPLIES WHEREAS, the Department of
Education, Schools Division of Nueva Ecija. needs to procure FIRST AID KIT FOR DRRM
SUPPLIES requested by School Bids And Awards Committee with an Approved Budget
for the Contract of Php 4,288.00

WHEREAS, the Bids and Awards Committee (BAC) after reviewing and validating the
needs to procure FIRST AID KIT FOR DRRM SUPPLIES ; WHEREAS. on motion of CRISTAL LEA
D. LEOPANDO duly seconded by EMMABELL R. NATALIO that the FIRST AID KIT FOR DRRM
SUPPLIES will be procure through Negotiated Procurement, Section 53.9 Small Value
Procurement (SVP) be used as the method of procurement;

NOW THEREFORE. We, the members of the Bids and Awards Committee (BAC).
hereby, RESOLVE. as it is hereby RESOLVED, to recommend to the Head of Procuring
Entity, the use of Negotiated Procurement Section 53.9 Small Value Procurement (SVP).
as alternative method of procurement for the procurement not exceeding
Php50.000.00. pursuant to 2017 Revised Implementing Rules and Regulations of Republic
Act9184;

RESOLVED FURTHER. that copies of this Resolution be furnished all concerned for
their information and appropri'ate action

Done in the Municipality of Bongabon this 15th day of March 2023

MOTION CARRIED UNANIMOUSLY.

EMMA~ATAllO
C airman

MARY ANN P. REYES

Vice - Chairman

ERLl~MOLINA
Member

APPROVED:
~ £n lr\\
PAME~GRDUELA
.ll MAR 1 6 2023 Jj
School Principal I
- --.!.I
f - ~. Ea
 0 Department of Education
. .,- ~.i.: :
Region III
Schools Division ofNueva Ecija
I~,..o
E DUKAS VON C
District ofBongabon
JAIME L, GAMILLA ELEMENTARY SCHOOL

INSPECTION AND ACCEPTANCE REPORT

Fund Cluster : 01

Supplier :LAMBERT TRADING IARNo.: (!,_MJ'l._- OJJ- 07

PO No./Date : ~ /)1-?; - 1x:, -1n L O"J -o 1- ~o 'J-3 Date : (!_?/ - £Ir :2-<n.P
Requisitioning Office/Dept. : v<l- J.t••i (l!:_(., l• G,,,,..;s/.?J l'i.5' Invoice No. : I ~.aro
Responsibility Center Code : '1 Date : b~ - Jc',,- ~:O

Stocki
Description Unit Quantity
Prooertv No.
1 HYDROGEN PEROXIDE BOTTLES 10
2 BETADINE BOTTLES 10
3 COTTON PCS 9
4 GAUZE BANDAGE PCS 10
5 MEDICAL TAPE PCS 10
6 BAND AID BOX 1
7 BIOGESIC PACK 1

INSPECTION ACCEPTANCE
D,_ ft,- !l,-0:J.J, Date Received : b'?- ~ - :u,~;;,
Date Inspected :

Inspected, verified and found in order --EJComplete

to quantity and specifications
<nls. snecifv ouantitv)
<r2 )
PAUSTITNA'°PllELA CRUZ M A R ~ REYES
Inspection Officer/In pection Committee I Supply and/or Property Custodian

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Jj ~AR 1 6 2023 }j
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 Q
Rtpubllc o1 tt,e Phllpplntt
Far BIR BCS/ l>tparlmtnl of Flnanc.
UN Onlv ftom: lllnau ol lnl!tmll Revtn..
1'0.
""
2307
Jarury 2018 (ENCS)
::a, :.. ..R r " -•-=
Certificate of Creditable Tax
Withheld at Source
. -•y•
1III1~.~tilllll --
1 Far lho Period Fram I 0, O ,I 12,b, ~.~l (M~ To It> ?J I 1f I fl, 6 , :I. , (MINDDIYYYY)
n--•-
2 T--Nunar(TW)
I ,~o . 1-1sa4, 1;1se2, f. 000 I
' '
3 " -'• N.,. (LulN.,., RntN.,,., - N - f o r - . i OR Rog/_ N.,. forNon-lnd/vldual}
I
LAMBERTTRADING
4 Rogillnd- 4A ZJPCodo
I
TALAVERA, NUEVA ECIJA
I F<nign - . , /I opp1icab1e
II 3.114 1

I
- n-.. - • • - ~ - -- • - -

I T-ldontification Numblt (TW)

~70 II 1-1
&18 I
7 P1)'01'1 Name (l.ut N.,,,., Firot N.,., l.liddle N - ,o,- ""'""" '" ' OR Reg,sl9raa
I
JAIME GAMILLA ELEMENTARY SCHOOL
N-
1-l 789' l - 'I
for Non-1na1v,au1/}
9,1, "t I I

IR~- IA ZJPCodo
I BONGABON NUEVA ECIJA 11 ~. J , :Z. ,
0 1rt 111- Details of Monthtu Income P . .... . ...., axes WJthhald
lncomt Paymtnls SubfKt ID Expondtd AMOUNT OF INCOME PAYMENTS Tu-f«ttle
- I n g Tu ATC 111t-ofttle 2nd llontlloftt,e 3rd Montll of ttle Toi.II Quar11r
~--r11, ~ ·-rtor ~ ••rtor

PLIOhase of Goods 1% 4,288.00 38.29

T-
lloney Payments Sullject ID Wllllholdlng ol
-Tax'Gonnwnent&Prlvatie' .,

Total 38.29
We - under the penalliea of perjury Iha! lhil - hall been in good fai1h, verified by ua, and lo tho boot of our knowledge end belief, Is lruo end C0n9Ct,
punuant lo the provisions of tho Nalional lntemal Rovonuo Code, • emended, and tho n,gulations isouod under authority thor1101. Further, we give our conoont to the pmcoosr,g
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