Department of Education

Regiom VI - Western Visayas

Division of Capiz
District of ____________

______________ ELEMENTARY SCHOOL

No. _______________
FOR THE PERIOD 2017
CASH DISBURSEMENTS REGISTER

TYPE OF WORKING FUND: MOOE

CASH ADVANCE BREAKDOWN OF PAYMENTS

REFERENCE OFFICE TELEPHONE R&M - OTHER ACCOUNTS
DATE (OR/RER/ PAYEE / AMOUNT BALANCE TRAVEL SUPPLIES WATER ELECTRICITY EXPENSES SECURITY SCHOOL ACCOUNT ACCOUNT
Check No. PARTICULARS RECEIVED PAYMENTS (6=4-5) EXPENSES EXPENSES EXPENSES EXPENSES - MOBILE SERVICES BUILDINGS NAME CODE AMOUNT
(5020101000) (5020301000) (5020401000) (5020402000) (5020502000) (2021202000) (5021304002)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16)

- - - - - - - - - - -

CERTIFIED CERTIFIED: NOTED:

CORRECT: SUPPORTING DOCUMENTS COMPLETE

BENJIE B. DOCE, CPA, MBA MIGUEL MAC D. APOSIN, Ed. D., CESO V
SCHOOL HEAD / DISBURSING OFFICER ACCOUNTANT III SCHOOLS DIVISION SUPERINTENDENT

DATE DATE DATE

 PURCHASE REQUEST
Department of Education
(Agency)

Division : CAPIZ PR No. : Date :

School : SAI No. : Date :

Stock No. Unit Description Quantity Unit Cost Total Cost

Total -
Purpose :

Requested by: Approved :

Signature :
Name :
Designation : Property Custodian School Head
 Annex G-7

INSPECTION AND ACCEPTANCE REPORT

Department of Education
(Agency)

Supplier IAR No.

PO No. Date Invoice No. Date:
Requisitioning Office/Dept.

Stock No. Unit Description Quantity

INSPECTION ACCEPTANCE

Date Inspected: 12/30/1899 Date Received: 12/30/1899

Inspected, verified and found OK Complete

as to quantity and specifications Partial
(pls. Specify quantity)

PROPERTY CUSTODIAN SCHOOl HEAD

 REQUISITION AND ISSUE SLIP
Department of Education
(Agency)

Division: CAPIZ Responsibility Center RIS No. Date

School: Code _________________ SAI No. Date

Requisition Issuance
Stock No. Unit Description Quantity Quantity Remarks

Purpose :

Requested by: Approved by: Issued by: Received by:

Signature
Name
Designation School Head Property Custodian
Date
 Appendix 35

PURCHASE ORDER
Department of Education
(Agency)
Supplier P.O. No.
Address Date
TIN Mode of Procurement CASH

Gentlemen:
Please furnish this office the following articles subject to the terms and conditions contained herein:

Place of Delivery: - Delivery Term: -

Date of Delivery: - Payment Term: -

Stock No. Unit Quantity Description Unit cost Amount

0 0 0 0 P - P -

(Total Amount in Words)

P -

In case of failure to make the full delivery within the time specified above, a penalty of one-tenth (1/10) of one (1) percent for every day of
delay shall be imposed.
Very truly yours,
Conforme:

SCHOOL HEAD
SUPPLIER

(Date)

Funds Available:
Amount: -

SCHOOL TREASURER ALOBS No.:

 Department of Education
Region VI - Western Visayas
DIVISION OF CAPIZ
City of Roxas

Please quote your price for furnishing and delivering immediately following supplies and materials and/or articles
needed by the office of the School Division Superintendent for Capiz, city of Roxas under Req. and issue voucher dated
.

QUOTATION
QTY. UNIT ARTICLES
UNIT PRICE TOTAL PRICE

TOTAL

It is requested that the quotation by you be actually your lowest price and should include delivery of supplies/materials and/
articles to the site of work. Failure on the part of the bidder to deliver the supplies / materials / or articles within ten (10) days
from the date of the awrd and/or articles will be imposed on the bidder from each day of delay.
It is requested that your proposal be enclosed in a sealed envelope and delivered to this office to be opened at _____ o'clock
A.M./P.M. on _ _.

School Head
I hereby certify that the prices above are the lowest price and that if accepted by the government the supplies/materials
and/or articles shall be delivered immediately.

Name and Signature of Bidder

 Department of Education
Region VI - Western Visayas
DIVISION OF CAPIZ
Roxas City

Abstract of Bids for furnishi for use in the which was

opened in the Office of the School Head of the said school at A.M./P.M.

BIDDERS PRICE
ARTICLES ABC MERCHANDISING DEF MERCHANDISING GHI MERCHANDISING

TOTAL - - -

We hereby certify to the correctness of the above quotation of prices as per attached proposal of the above named bidders which were opened in the presence of :

School Property Custodian School Teasurer/Disbursing Officer

APPROVED for the purpose from dealer as checked above.

School Head Name of Bidder Resident Auditor

 Revised January 1992

REIMBURSEMENT EXPENSE RECEIPT

Date: No.

Received from ______________ ____________

(Name)

of _______ ________ the amount

of _________ _______ _( )_______

(In Words) (In Figure)

(payments for subsistence, services, rental or transportation

should show inclusive date, purpose, distance, inclusive points of travel)

etc. ________________________________________________________

WITNESS PAYEE

Name/Signature: _
Address: _
Residence Cert. No. _
Date of Issue _
Place of Issue _
 Department of Education
Region VI - Western Visayas
Division of Capiz
______________ ELEMENTARY SCHOOL

JOB ORDER

Job Order :
Date:

To:

Completion time from this date the job order is received by the contractor

Item No. Explanation/Description/Specification:

Wages of Laborers for the period:

Nature of Work:

1.
2.
3.

Obligation No.:

Funds Available: MOOE

Approved:

School Head

Accepted:
 ACKNOWLEDGMENT RECEIPT FOR EQUIPMENT
Department of Education
Division of Capiz
(Agency)
Quantity Unit Description Property No.

Received by: Received from:

Signature Over Printed Name Signature Over Printed Name

Property Custodian School Head

Position / Office Position / Office

Date Date
 Department of Education
Division of Capiz

PROGRAM OF WORKS
I. Name of Project:
II. Project Location:
III. Project Proponent:
IV. Project Beneficiaries:
V. Source of Fund:
VI. Time Frame:
VII. Budget Proposals:
A. Materials:
Quantity Unit Description Unit Cost Total Cost

Total: -

B. Labor:

Total -

Prepared by:

Industrial Arts Teacher

Noted:

School Head
 Department of Education
Division of Capiz
0
0

ACCEPTANCE OF FINISHED MINOR REPAIRS

Name of Project:
Source of Fund:
Program of Works:
Quantity Unit Description Unit Cost

TOTAL

Expenses:

Labor
Materials

Total

Note:

Verified, inspected and found correct as to

program of works and specifications:

Chairman member 1 member 2

Inspection Committee Industrial Arts Teacher Property Custodian
 Department of Education
Division of Capiz

NCE OF FINISHED MINOR REPAIRS

Total Cost

-
-

Property Custodian
 Department of Education
Region VI - Western Visayas
Division of Capiz
District of

CONSUMPTION REPORT FOR GASOLINE

MOOE

Received the material/s as indicated hereunder for grass cutting of school ground with an
estimated area of square meters.

QTY. UNIT ARTICLES U/P

TOTAL:

Received by:

School Property Custodian

Noted:

School Head
s

GASOLINE

utting of school ground with an

AMOUNT

-
 APPENDIX A
No.
Date:
ITINERARY OF TRAVEL
Name: Position:
Official Station: DepEd, Capiz Division Monthly Salary:
Purpose of Travel:
Means of
Date Place to Visit Departure Arrival Transportation Fare Per Diems Total

Total
(2) (1) I HEREBY CERTIFY THAT I have reviewed the (1) Prepared by:
foregoing itinerary, (2) the travel is necessary to the service,
(3) the period covered is reasonable, (4) the expenses claimed
are proper.
(2) Approved by:

Supervisor/Immediate Supervisor Public Schools District Supervisor

APPENDIX B
DECS, DIVISION OF CAPIZ Date:
MIGUEL MAC D. APOSIN, Ed.D., CESO V Station: DepEd, Capiz Divisi
Agency Head

I hereby certify that I have completed the travel authorized in the Itinerary of Travel No.______ dated________________________
under the conditions indicated below.

_____________ Strictly in accordance with the prepared itinerary:

_____________ Cut short explained below. Excess payment in the amount of_____________________________________
was refunded under O.R. No.________ dated__________________________________________________
_____________ Extended as explained below: Additional itinerary was submitted:
_____________ Other deviations as explained below:
________________________________________________________________________________________________

Attached supporting documents: Certificate of Appearance

___________________________________________________________________________.

On evidence and information of which I have knowledge, the travel was undertaken.
Respectfully submitted:
 Department of E
Region VI - Wester
Division of Cap
District of _______
ELEM

FOR THE PERIOD

CASH DISBURSEMEN

TYPE OF WORKING FUND: MOOE

CASH ADVANCE
REFERENCE
DATE (OR/RER/ PAYEE / AMOUNT BALANCE
Check No. PARTICULARS RECEIVED PAYMENTS (6=4-5)

(1) (2) (3) (4) (5) (6)

01/17/2017 CASH JUAN DELA CRUZ 10,000.00 10,000.00
01/18/2017 OR# 0123 ABC MERCHANDISING 5,000.00 5,000.00
01/20/2017 OR# 0888 XYZ CONSTRUCTION SUPPLY 5,099.99 (99.99)

10,000.00 10,099.99 (99.99)

CERTIFIED CERTIFIED:
CORRECT: SUPPORTING DOCUMENTS COMPLETE

BENJIE B. DOCE, CPA, MBA

SCHOOL HEAD / DISBURSING OFFICER ACCOUNTANT III

DATE DATE
 Department of Education
Region VI - Western Visayas
Division of Capiz
District of ____________
ELEMENTARY SCHOOL

FOR THE PERIOD 2017

CASH DISBURSEMENTS REGISTER

BREAKDOWN OF PAYMENTS
OFFICE TELEPHONE R&M - OTHER ACCOUNTS
TRAVEL SUPPLIES WATER ELECTRICITY EXPENSES SECURITY SCHOOL ACCOUNT
EXPENSES EXPENSES EXPENSES EXPENSES - MOBILE SERVICES BUILDINGS NAME
(5020101000) (5020301000) (5020401000) (5020402000) (5020502000) (2021202000) (5021304002)
(7) (8) (9) (10) (11) (12) (13) (14)

OTHER MOOE
5,099.99

- 5,099.99 - - - - -

NOTED:
OCUMENTS COMPLETE

NJIE B. DOCE, CPA, MBA MIGUEL MAC D. APOSIN, Ed. D., CESO V
ACCOUNTANT III SCHOOLS DIVISION SUPERINTENDENT

DATE DATE
 No. _______________

OTHER ACCOUNTS
ACCOUNT
CODE AMOUNT

(15) (16)

5029999099 5,000.00

5,000.00

ESO V
NT
 PURCHASE ORDER
Department of Education
(Agency)

Supplier 0 P.O. No. 01

Address Date 30-Dec-99
TIN Mode of Procurement CASH

Gentlemen:

Please furnish this office the following articles subject to the terms and conditions contained herein:

Place of Delivery: - Delivery Term: -

Date of Delivery: - Payment Term: -

Stock No. Unit Quantity Description Unit cost

0 0 0 0 P

(Total Amount in Words)

Five Thousand Pesos Only.

In case of failure to make the full delivery within the time specified above, a penalty of one-tenth (1/10) of one (1) pe
delay shall be imposed.

Very truly yours,

Conforme:
0
0 SCHOOL HEAD
SUPPLIER

12/30/1899
(Date)

Funds Available:
Amount:
MARJORIE GERAPUSCO
SCHOOL TREASURER ALOBS No.:
 Appendix 35

Dec-99
CASH

-
-

Unit cost Amount

- P -

P -

one-tenth (1/10) of one (1) percent for every day of

0
SCHOOL HEAD