Entity Name: Department of Education No.

:
Fund Cluster: MOOE
Name : Date of Travel:
Position : Purpose of Travel:
Official Station:

Time Means of
Total
DATE Places Visited Transporta Transpo Per Diem Others
Departure Arrival -tion Amount

8/5/2019 Poblacion, Guindulman to Tagbilaran Dao Terminal 7:00 am 09:10 am Van 120.00 180.00 300.00
Dao Terminal to Division Office 09:10 am 09:25 am Tricycle 30.00 30.00
Division Office to Dao Terminal 03:30 pm 03:45 pm Tricycle 30.00 30.00
Dao Terminal to Guindulman Residence 04:00 pm 06:10 pm Van 120.00 120.00
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Page 1 of 5
 Time Means of
Total
DATE Places Visited Transporta Transpo Per Diem Others
Departure Arrival -tion Amount

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TOTAL 300.00 180.00 - 480.00
Prepared by:

I certify that (1) I have reviewed the foregoing

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

Signature over Printed Name Signature over Printed Name

Immediate Supervisor Agency Head/Authorized Representative

Page 2 of 5
 APPENDIX 47

CERTIFICATION OF TRAVEL COMPLETED

Entity Name: Fund Cluster: 101

NERITA A. BUMOTAD MAYUGA NATIONAL HIGH SCHOOL

arge Station

I hereby certify that I have completed the travel as authorized in the Travel Order/Itinerary of
Travel No. dated under conditions indicated below.

o Strictly in accordance with the approved itinerary

o Cut short as explained below. Excess payment in the amount of ____________was refunded in
OR Number ___________ dated ___________________.
o Extended as explained below. Additional itinerary was submitted.
o Other deviations as explained below.

Explanation or Justification:

Evidence of travel attached hereto:

Travel authority, Certificate of Appearance, Appendix A & B, Official Receipts, Disbursement

Voucher and other documents.

Respectfully Submitted:

Name of Employee

On evidence and information of which I have knowledge, the travel was actually undertaken.
Name of Director
Office
 DEPARTMENT OF EDUCATION
CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS
Pursuant to COA Circular No. 200017-001 dated June 19, 2017
Name of Employee Employee No.
Office
Division
Particulars Amount (P)
8/5/2019 Poblacion, Guindulman to Tagbilaran Dao TerminVan 120.00 120.00
Dao Terminal to Division Office Tricycle 30.00 30.00
Division Office to Dao Terminal Tricycle 30.00 30.00
Dao Terminal to Guindulman Residence Van 120.00 120.00
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12/30/1899 0 0 - -
12/30/1899 0 0 - -
12/30/1899 0 0 - -
12/30/1899 0 0 - -
12/30/1899 0 0 - -
12/30/1899 0 0 -
12/30/1899 300.00

Purpose of Travel:

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

Signature

Printed Name

Employee Immediate Supervisor

Date Date