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ANNEX A

Republic of the Philippines


Department of Education
Region VII, Central Visayas
Division of Lapu-lapu City
TEL. NO. (032) 340-7887 ; 340-5031
TELEFAX NO. (032) 495-4655

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS


Pursuant to COA Circular No. 2017-001 dated June 19, 2017

Name of Employee MARI TERESA I.ECLEO Employee 4367486


No.
SABANG ELEMENTARY SCHOOL
Office
LAPU – LAPU CITY
Division
Particulars Amount (₱)
To payment for sixty – eight containers delivery of water supply for 340.00
SBFP of Sabang Elem. School from Oct. to Dec. 2017 in the amount
of…..

TOTAL 340.00

Purpose

SCHOOL BASE FEEDING PROGRAM

I hereby certify that the above expenses are incurred as they are necessary for the
above cited purpose, that above good and services were acquired from partied not
issuing receipts. And that I am fully aware that willful falsification of statements is
punishable by law.

Certified correct: Noted by:

Signature

Printed Name MARIA TERESA I. ECLEO ROEL E. VERSALES

Employee Immediate
Supervisor
Date 1-29-18 Date 1-29-18