Mooe Forms

Republika Ng Pilipinas
KAGAWARAN NG EDUKASYON
Rehiyon XI
Sangay Ng Compostela Valley
PUROK NG HILAGANG LAAK
LIQUIDATION REPORT
DEPED- Compostela Valley Division
LAAK DISTRICT
No.
Date:
Responsibility Center:
Code:
PARTICULARS
AMOUN
To LIQUIDATE the CASH ADVANCE from the MOOE for the month of
November, 2015
in the amount of
Nine thousand nine hundred
sixty-nine and fifty cents (P9,969.50)
with check
number
161531 dated
12/7/2015
.
TOTAL AMOUNT SPENT

AMOUNT OF CASH ADVANCE PER DV NO. _____ DTD._______
AMOUNT TO BE REFUNDED PER OR NO. _____ DTD ______
AMOUNT TO BE REIMBURSED
A.
B.
Certified: Correctness of
Certified: Purpose of
the above data
travel/Cash advance duly
accomplished
IAN JANE G. LUMBAY

Claimant
DONATO B. JUAYANG
District Coordinating Principal
P9,969.5
C.
Certified: Supporting documents comp

proper
PHOEBE GAY L. REFAMON

DIVISION ACCOUNTANT
Appendix 58
AMOUNT
P9,969.50
fied: Supportdocuments complete and
AY L. REFAMONTE, CPA
ON ACCOUNTANT III
JEV No.
Rehiyon XI
DISBURSEMENT VOUCHER
Mode of
Payment
MDS Check
Payee
NO.:
Commercial Check
ADA
TIN/EMPLOYEE NO:
JONALYN S. LUNGAN
Responsibility Center
Address
Office/Unit/Project
SABUD, LAAK, COMVAL
EXPLANATIONS
Payment for the travel expenses.
A. Certified:
B. Approved for Payment:

Cash Availability
Subject to Authority to Debit Account
Supporting documents complete
Signature
Printed
Name
Position
Date
Signature
Printed
Name
Position
Date
IAN JANE G. LUMBAY

TIC/T-III
C. Received Payments:
Check/
ADA No.
Signature
Date:
Bank Name
Date:
Printed
Name
IAN JANE G. LUMBA

TIC/T-III
Others
OS/BUR No:
bility Center
Code
AMOUNT
720
Payment:
JANE G. LUMBAY
TIC/T-III
JEV No.
Date
Rehiyon XI
PURCHASE REQUEST
Division:
School:
Stock No.
PR No:
SAI No:
Quantity
Item Description
Total
Purpose
Requested by:
Signature
Printed
Name
Designation
Unit
Appendix 51
ST
Unit Cost
Approved by:
Total Cost
Rehiyon XI
PURCHASE ORDER
Supplier:
Address:
TIN
PO No:
Date:
Mode of Procurement: _______________
Office:
-------------------------------------------------------------------------------------------------------------------------------Gentlemen:
Please furnish this Office the following articles subject to the terms and contidions contained here
-------------------------------------------------------------------------------------------------------------------------------Place of Delivery
Delivery Term
Date of Delivery
Item No.
Unit
Quantity
Description
Grand Total
In case of failure to make the description
(1/10) of one percent for every day of delay shall be imposed.
Conforme:
Very truly yours,

Signature over printed Name of Supplier
Date
Funds Available:
OBR No.
PHOEBE GAY L. REFAMONTE, CPA

Division Accountant III
Amount:
Appendix 52
rement: _______________
--------------------
ntidions contained herein:

--------------------
Unit Cost
Grand Total
ruly yours,
Total Cost
Rehiyon XI
OPEN CANVASS
Dealer:
Address:
Canvass No.
Date:
Office:
Please quote your price for each of the following articles below which we may purchase
from you should be your quotation is the most reasonable and advantageous to us:
Item No.
Quantity
Unit
Description
TOTAL
Signature of Bidder
Canvass by:
Printed Name of Bidder

Approved:
BAC Chairman
ch we may purchase
Unit Price
Total Amount
Canvasser
Rehiyon XI
Nabunturan
Date:
Bid. No.
Office:
ABSTRACT OF BIDS
Note: With asterisk (****) winning bidder
No.
Quantity
Unit (s)
Description and Specification
Unit Price
Amount
Unit Price
The undersign after reviewing and evaluating the request for quotations listed above find the price and terms of ________________________
as most advantageous to the government and the HOPE approves the purchase of the described items. This request for quotation posted at DEPED
bulletin Board.
BAC Chairman
BAC Secretariat
Member
Amount
Unit Price
Amount
Approved:
Head of Procuring Entity
Rehiyon XI
REQUISITION AND ISSUE SLIP

Division:
School:
PO No.:
Responsibility Center:
Code:
Date of Delivery:
Requisition
Stock No.
Unit
Description
Quantity
Purpose
Requested by:
Received by:
Issued by:
Approved by:
School Property Custodian
Date:
Appendix 50
UE SLIP
RIS NO:
SAI NO:
Amount:
Issuance
Quantity
Total Cost
Rehiyon XI
INSPECTION AND ACCEPTANCE REPOR

Supplier:
PO No.:
Requisitioning Office/Dept:
Stock No.
Invoice No.
Date:
Unit
Description
INSPECTION
ACCEPTANCE
Date Inspection:
Date:
Inspected, verified and found in order as to
quantity and specifications
Date Received:
Date:
Complete
Partial (Pls. specify quantity)

Inspectorate
Inspectorate
________________________________
School Property Custodian
Inspectorate
Appendix 64
NCE REPORT
IAR No.:
Date:
ACCEPTANCE
l (Pls. specify quantity)
__________________
ol Property Custodian
Quantity
Rehiyon XI
ITINERARY OF TRAVEL
Name:
Office:
SABUD ES
Purpose of Travel:
Date
10/8/2015
IAN JANE G. LUMBAY

To attend QCC, claim MMOE check, submit report.
Place to be visited
Sabud
LS Sarmiento
11/4/2015
Sabud
Barubo
Sabud
Anitap
Sabud
Sisimon
Sabud
Laak
Tagum
Nabunturan
Tagum
Laak
LS Sarmiento
Sabud
Barubo
Sabud
Anitap
Sabud
Ssimon
Sabud
Laak
Tagum
Nabunturan
Tagum
Laak
Sabud
Time
Departure
6:00
4:00
1:00
4:00
6:00
4:00
6:00
4:00
6:00
7:00
9:00
11:30
1:00
3:00
Arrival
7:40
5:40
2:00
5:00
7:20
5:20
7:00
4:00
7:00
9:00
9:40
12:10
3:00
4:00
Means of
Transportation
Motorcyle
I hereby certify that I have reviewed the foregoing itinerary.

The travel necessary to the service.The period covered is
responsible. The expenses claimed are proper.
Certified by:
DONATO B. JUAYANG
Approved by:
DONATO B. JUAYANG
Appendix 51
inas
KASYON
a Valley
TRAVEL
Date:
Position:
submit report.
TIC/T-III
Allowable Expenses
Trans.
Per Diem
400
400
350
350
320
320
300
300
300
50
40
40
50
300
80
Daily
Allowance
Total
800
700
640
600
860
3,600
Prepared by:
JUAYANG
Principal
IAN JANE G. LUMBAY

TIC/T-III
Rehiyon XI
CERTIFICATE OF TRAVEL COMPLETED

DONATO B. JUAYANG
Agency Head
SABUD ES
Station
DCP
Designation
Date
I CERTIFY that I have completed the travel authorized in Itinerary No. ________ dated
Strictly in accordance with the approved itinerary.

Cut short as explained below Excess payment in the amount
of Php ______________ was refunded under OR # __________
dated ______________.
Extended as explained below additional itinerary was submitted.
Other deviation or justification:
Evidence of Travel:
/
/
Used Tickets
Certificate of Appearance
Others
RER,TO,MEMO
Respectfully yours,
JONALYN S. LUNGAN
CLAIMANT
On evidence and information of which I have acknowledged, the travel was actually undertaken.
IAN JANE G. LUMBAY

TIC
PLETED
SABUD ES
Station
Date
___ dated
mount
submitted.
YN S. LUNGAN
CLAIMANT
tually undertaken.
JANE G. LUMBAY
TIC
Rehiyon XI
ACCOMPLISHMENT REPORT (TRAV

Name:
Office/School:
Division:
Position
Date
10.7.2015
Destination
L.S.Sarmiento ES,Laak
Prepared by:
Teacher
Purpose
To attend Quality Circle Conference
Accom
Attended Qua
T (TRAVEL)
Accomplishment
Attended Quality Circle Conference
No LEGACY is so rich as HONESTY

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TOTAL AMOUNT SPENT

IAN JANE G. LUMBAY

Certified: Supporting documents comp

PHOEBE GAY L. REFAMON

fied: Supportdocuments complete and

Payment for the travel expenses.

B. Approved for Payment:

IAN JANE G. LUMBAY

IAN JANE G. LUMBA

Very truly yours,

PHOEBE GAY L. REFAMONTE, CPA

ntidions contained herein:

Printed Name of Bidder

Description and Specification

REQUISITION AND ISSUE SLIP

School Property Custodian

INSPECTION AND ACCEPTANCE REPOR

Partial (Pls. specify quantity)

l (Pls. specify quantity)

IAN JANE G. LUMBAY

I hereby certify that I have reviewed the foregoing itinerary.

IAN JANE G. LUMBAY

CERTIFICATE OF TRAVEL COMPLETED

Strictly in accordance with the approved itinerary.

IAN JANE G. LUMBAY

ACCOMPLISHMENT REPORT (TRAV

No LEGACY is so rich as HONESTY

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