Professional Documents
Culture Documents
No. Date:
May 3, 2012
CLASSIFICATION OF DISBURSEMENT
Regular Cash Advance Other Payment MDS Check
MODE OF PAYMENT
Commercial Check Cash
Name of Claimant: SONIA L. PINALBA Address: LONOY NATIONAL HIGH SCHOOL, SAPIAN, CAPIZ PARTICULARS To payment of travel expenses while on official travel, as per supporting apers hereto attached in the amount.
PHP
1,360.00
1,360.00
Date:_____________________________
1,360.00
Bank Name:__________________________
O.R. No.______________________________
Prepared by:
May 3, 2012
Others
NT
Amount
1,360.00
1,360.00
yment:
ee Hundred Sixty
DA O. FACINAL
rincipal - I
______Date_______
______Date_______
Annex G-3
Amount Credit
APPENDIX A
No.: Date: May 03, 2012
Name: SONIA L. PINALBA Official Station: LONOY NATIONAL HIGH SCHOOL Purpose of Travel: On official Travel Date
March 8, 2012 March 10, 2012 April 24-25, 2012
Place of Visit
Station- Roxas City Station- Roxas City Station- Roxas City
Departure Arrival
6:00 A.M. 6:00 A.M. 6:00 A.M. 7:00 A.M. 7:00 A.M. 7:00 A.M.
Means of Transportation
Jeepney & Tricycle Jeepney & Tricycle Jeepney & Tricycle
Fare
100.00 100.00 200.00
Per Diems
240.00 240.00 480.00
TOTAL (2) (1) I HEREBY CERTIFY THAT I have received the foregoing itinerary, (2) the travel is necessary to the service, (3) the period covered is reasonable, (4) the expenses claimed are proper. ZENAIDA O. FACINAL Supervisor/Immediate Supervisor (1) Prepared by:
400.00
960.00
APPENDIX B
ZENAIDA O. FACINAL (Agency Head) Principal I (Designation) LONOY NATIONAL HIGH SCHOOL (Station) ___________________________ (Date)
I hereby certify that I have completed the travel authorized in the itinerary of Travel No. dated May 3, 2012 under the conditions indicated below. ______________ Strictly in accordance with the prepared itinerary. ______________ Cut short explainrd below Excess payment in the amount _______________________________ was refunded under O.R. No dated___________________________________________________ ______________ Extended as explained below: Additional itinerary was submitted: ______________Other deviations as explained below: _____________________________________________________________________________________________________ Attached supporting documents: Certificate of Appearance, Travel Order
On evidence and information of which I have knowledge, the travel was undertaken. Respectfully submitted: SONIA L. PINALBA Name of Employee Teacher - I Designation
Total
340.00 340.00 680.00
1,360.00
IGH SCHOOL
__________
______________ ________________
_______________________
bmitted:
Teacher - I Designation
Republic of the Philippines Department Of Education Region VI - Western Visayas DIVISION OF CAPIZ LONOY NATIONAL HIGH SCHOOL Lonoy, sapian, Capiz March 9, 2012
AUTHORITY TO TRAVEL
From: From:
Approved for: