Republic of the Philippines

Department of Education
Region IV – A CALABARZON AUTHORITY TO TRAVEL
DIVISION OF LIPA CITY
Lipa City

NAME OF OFFICIAL/EMPLOYEE NO.

POSITION OFFICIAL STATION

DESTINATION PERIOD OF TRAVEL

PURPOSE Please check:

[ / ] Official Business
[ ] Official Time Only
ESTIMATED EXPENSES Please refer:
Registration Fee Transportation Travel Allowance Total Amount
[ ] Cash Advance
[ ] Reimbursement

REQUESTED BY: FUNDS AVAILABLE

APPROVED:

FLORDELIZA S. PUNZALAN REMELYN B. DE GALICIA

School Principal II Accountant III LUDY N. PASAGUI, Ed. D
DATE: Schools Division Superintendent
Officer-In-Charge
October 18, 2017
SOURCE OF FUND:
MOOE FUND