Entity Name : OSDS -

Fund Cluster: 101101 No.: 12

Name : Date of Travel :

Position : Purpose of Travel :
Official Station :
Places to be visited TIME Means of Transpor- Per
Date Others
(Destination) Departure Arrival Transportation station Diem

TOTAL
Prepared by :

I certify that : (1) I have reviewed the foregoing _______________________________

itinerary, (2) the travel is necessary to the Signature over Printed Name
service, (3) the period covered is reasonable and
(4) the expenses claimed are proper.
Approved by:

Page 1 of 9
LUISITO L. REYES ZENIA G. MOSTOLES, Ed. D., CESO V
Teacher I/TIC Schools Division Superintendent

Page 2 of 9
 No.: 12

Total
Amount

_______________________________
Signature over Printed Name

Page 3 of 9
ZENIA G. MOSTOLES, Ed. D., CESO V
Schools Division Superintendent

Page 4 of 9
Entity Name : OSDS -
Fund Cluster: 101101 No.: 12

Name : Date of Travel :

Position : Purpose of Travel :
Official Station :
Places to be visited TIME Means of Transpor- Per
Date Others
(Destination) Departure Arrival Transportation station Diem

TOTAL
Prepared by :

I certify that : (1) I have reviewed the foregoing _______________________________

itinerary, (2) the travel is necessary to the Signature over Printed Name
service, (3) the period covered is reasonable and
(4) the expenses claimed are proper.
Approved by:

Page 5 of 9
 LESLY NOPAL LUISITO L. REYES
Designated Disbursing Officer Teacher I/TIC

Page 6 of 9
 No.: 12

Total
Amount

_______________________________
Signature over Printed Name

Page 7 of 9
LUISITO L. REYES
Teacher I/TIC

Page 8 of 9
 Appendix 46

REIMBURSEMENT EXPENSE RECEIPT

Entity Name: _________________ Fund Cluster : ________________

Date : _______________________ RER No. : ___________________

RECEIVED from ______________________________________

(Name)

_________________________________________________ the amount

(Official Designation)

of __________________________________________ (P__________)
(In Words) (in Figures)

in payment for _______________________________________________

(Payments for subsistence, services,

_________________________________________________________
rental or transportation should show inclusive dates,

_________________________________________________________
purpose, distance, inclusive points of travel, etc.)
PAYEE
Name/Signature __________________________________________
Address ________________________________________________

WITNESS
Name/Signature __________________________________________
Address ________________________________________________

Document Code: SDO-BUL-QF-OSDS-ACC-017

Revision No.: 02

Effectivity Date: 08-18-2018

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