Republic of the Philippines

Department of Education
Region VII, Central Visayas

DIVISION OF CEBU PROVINCE

IPHO Bldg., Sudlon, Lahug, Cebu City

(school name)
(district)
(address)

March 11, 2019

CERTIFICATION

I hereby certify that I physically checked the property listed here in pages (1) to (?)
inclusive this 1st day of April 2019 and the same is found in (name of school), (district),
(address)covered with valid receipts. I personally assumed responsibility which I promise to
account for when requested to do so by proper authority. I know that in accepting receipts for
property under the charges for teacher and the employee directly responsible to me. I am
hereby accepting full responsibility for all property covered therein and liable for shortages in
the future.

(name of accountable officer)

(official designation)

Noted by:

(name of district/school authority)

(official designation)