DOLOMATRIX PHILIPPINES, INC. LIQUIDATION REPORT NAME Jose Paulo A Santos DATE _September 15, 2016 DETAILS OF ADVANCES FOR LIQUIDATION DATE REFERENCE NATURE OF CASH ADVANCE AMOUNT TOTAL ACTUAL LIQUIDATION OF CASH ADVANCES DATE PARTICULARS ‘AMOUNT, 15-Sep-16 _ Travel Fare 60.00 16-Sep-16 _|Notarial Fee 3,100.00 {15-Sep-16 _|PTT Application Fea 9,000.00. TOTAL, 12,160.00 SUMMARY OF LIQUIDATION REPORT: TOTAL CASH ADVANCE MADE a — > LESS: TOTAL AMOUNT LIQUIDATED | ———-—=——————-—-—-—————> NET DUE/PAYABLE () nd PREPARED BY: AUDITED BY: APPROVED BY. IRASANTOS MIM) AOM/ MG: NNV 7 ANV ugFRM.DOCAccownranur For No. 51-C ReVised January, 1992 (ORIGINAL) Official Receipt of the Republic of the Philippines Ne 8027221. 1 [owe Ah IDI Le etn tam fo, [PY | [roe Difonratnd = DUT pois Amount 7B [A cas DO check 1 Money Order Received the amount stated abo NOTE: Write the number and date of this receipt on the back of check or money order received. escetthiRy thy d 90-0018 40} uawiAed se SL bN ~ £36650 ON dal ‘S102 ‘LE 48quiazag InUA Dov Pa Perou plvcawonog “01 Pane2ay area 1d139]94