Appendix 45

ITINERARY OF TRAVEL

Entity Name :PHILIPPINES STATISTICS AUTHORITY

Fund Cluster: GENERAL FUND No.: _______________

NAME : LEA J. GIMEDA Date of Travel : 11-15 August, 2020

Position : Enumerator Purpose of Travel :
Attendance to the 2020 CPH 4th Level Training on August 11-15, 2020 in NORSU
Siaton Campus, Siaton, Negros Oriental.
Official Station : Siaton
Places to be visited TIME Means of Transpor Per Total
Date Others
(Destination) Departure Arrival Transportation -station Diem Amount
-
August 11 Residence(Casalaan)-Habalhabal Terminal 7:16 AM 7:38 AM Habal-Habal 50.00 50.00
Habalhabal Terminal-NORSU Campus 7:42 AM 7:55 AM trisikad 10.00 10.00
NORSU Campus-Habalhabal Terminal 5:32 PM 5:40 PM trisikad 10.00 10.00
Habalbal Terminal-Residence 5:43 PM 6:05 PM Habal-Habal 50.00 50.00
August 12 Residence(Casalaan)-Habalhabal Terminal 7:20 AM 7:42 AM Habal-Habal 50.00 50.00
Habalhabal Terminal-NORSU Campus 7:45 AM 7:57 AM trisikad 10.00 10.00
NORSU Campus-Habalhabal Terminal 5:40 PM 5:52 PM trisikad 10.00 10.00
Habalbal Terminal-Residence 5:57 PM 6:21 PM Habal-Habal 50.00 50.00
August 13 Residence(Casalaan)-Habalhabal Terminal 7:15 AM 7:40 AM Habal-Habal 50.00 50.00
Habalhabal Terminal-NORSU Campus 7:46 AM 7:57 AM trisikad 10.00 10.00
NORSU Campus-Habalhabal Terminal 5:35 PM 5:46 PM trisikad 10.00 10.00
Habalbal Terminal-Residence 5:52 PM 6:15 PM Habal-Habal 50.00 50.00
August 14 Residence(Casalaan)-Habahabal Terminal 7:15 AM 7:38 AM Habal-Habal 50.00 50.00
Habalhabal Terminal-NORSU Campus 7:45 AM 7:55 AM trisikad 10.00 10.00
NORSU Campus-Habalhabal Terminal 5:35 PM 5:46 PM trisikad 10.00 10.00
Habalbal Terminal-Residence 5:50 PM 6:15 PM Habal-Habal 50.00 50.00
August 15 Residence(Casalaan)-Habalhabal Terminal 7:18 AM 7:40 AM Habal-Habal 50.00 50.00
Habalhabal Terminal-NORSU Campus 7:46 AM 7:58 AM trisikad 10.00 10.00
NORSU Campus-Habalhabal Terminal 5:33 PM 5:45 PM trisikad 10.00 10.00
Habalbal Terminal-Residence 5:51 PM 6:06 PM Habal-Habal 50.00 50.00
-
-
-
-
-
-
-
-
-
-

600.00 - 600.00
TOTAL
Prepared by :

I certify that : (1) I have reviewed the foregoing itinerary, (2) the LEA J. GIMEDA
travel is necessary to the service, (3) the period covered is Signature over Printed Name
reasonable and (4) the expenses claimed are proper.
Approved by:

REALLY MAY C. ALCANTARA ARIEL T. FORTUITO

Signature over Printed Name Signature over Printed Name
Immediate Supervisor Agency Head/Authorized Representative

121
 PHILIPPINE STATISTICS AUTHORITY- Negros Oriental
(Agency Name)
CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS
Pursuant to COA Circular No. 2017-001 dated June 19, 2017
Name of Employee Employee no.
LEA J. GIMEDA
461518
Office PHILIPPINE STATISTICS AUTHORITY
Division STATISTICAL
Particulars Amount (P)
August 11,2020 Residence (Casalaan)- NORSU Campus 60
NORSU Campus- Residence 60
August 12,2020 Residence (Casalaan)- NORSU Campus 60
NORSU Campus- Residence 60
August 13,2020 Residence (Casalaan)- NORSU Campus 60
NORSU Campus- Residence 60
August 14,2020 Residence (Casalaan)- NORSU Campus 60
NORSU Campus- Residence 60
August 15,2020 Residence (Casalaan)- NORSU Campus 60
NORSU Campus- Residence 60

TOTAL 600
Purpose
Attending the 2020 Census of Population and Housing (2020 CPH) 4th Level Training on 11-15 August 2020 in Negros Oriental State University
(NORSU) Siaton Campus, Brgy. 3, Siaton, Negros Oriental.

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

Certified correct Noted by:

Signature
Printed Name LEA J. GIMEDA Really May C. Alcantara
ENUMERATOR Head CAS
Date Date
 PHILLIPINE STATISTICS AUTHORITY - NEGROS ORIENTAL Fund Cluster :
Entity Name Regular Fund
Date : 11-15 August 2020
DISBURSEMENT VOUCHER DV No. :
2020-05-

Mode of MDS Check Commercial Check ADA Others (Please specify)

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee LEA J. GIMEDA
461518
SIATON
Address

Responsibility
Particulars MFO/PAP Amount
Center

TO REIMBURSEMENT of Travelling expenses 24008030000746 600.00

incurred while on Official travel relative to
Attendance to the 2020 CPH 4th Level Training on
August 11-15, 2020 in NORSU Siaton Campus,
Siaton, Negros Oriental.

Amount Due 600.00

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

REALLY MAY C. ALCANTARA

Immediate Supervisor

B. Accounting Entry:
Account Title UACS Code Debit Credit
Travelling expenses 50201010 00 600.00
Cash, MDS, Regular 10104040 00 600.00
C. Certified: D. Approved for Payment
Cash available
Subject to Authority to Debit Account (when applicable)
Sup
proper

Signature Signature

Printed
Printed Name
Name SARAH JANE M. BOLONGAITA ARIEL T. FORTUITO
AO 1/BOOKKEEPER DESIGNATE PROVINCIAL STATISTICS OFFICER
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative

Date Date

E. Receipt of Payment JEV No.

Check/ Date : Bank Name & Account Number:
ADA No. :
Date : Printed Name: Date
Signature :
 Signature : Date : Printed Name:

Official Receipt No. & Date/Other Documents

 OBLIGATION REQUEST AND STATUS Serial No. 0

PHILIPPINE STATISTICS AUTHORITY Date : 11-15 August 2020

Entity Name Fund Cluster : Regular Fund

Payee LEA J. GIMEDA

Office Philippine Statistics Authority

Address SIATON
UACS Object
Responsibility Center Particulars MFO/PAP Amount
Code

24008030000746 TRAVELLING EXPENSES 50201010 00 600.00

Total 600.00
A. Certified: Charges to appropriation/alloment are B. Certified: Allotment available and obligated
necessary, lawful and under my direct supervision;and for the purpose/adjustment necessary as
supporting documents valid, proper and legal indicated above

Signature : ___________________________________ Signature : ______________________________

Printed Name: ARIEL T. FORTUITO Printed Name: SARAH JANE M. BOLONGAITA

Position : PROVINCIAL STATISTICS OFFICER Position : AO 1/ BOOKKEEPER DESIGNATE

Head, Requesting Office/Authorized Head, Budget Division/Unit/Authorized
Representative Representative
Date : Date :

C. STATUS OF OBLIGATION
Reference Amount
Balance
ORS/JEV/Check/ Obligation Payable Payment Due and
Date Particulars Not Yet Due
ADA/TRA No. Demandable
(a) (b) (c) (a-b) (b-c)

11-15 August 600.00 600.00 600.00 - -

To reimbursement of travelling
expenses incurred while on
Official travel relative to

600.00 600.00 600.00

endix 47

CERTIFICATION OF TRAVEL COMPLETED

Entity Name: Philippine Statistics Authority Fund Cluster: General Fund

ARIEL T. FORTUITO Siaton

Chief Statistical Specialist 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:
travel no. 2020-07-SR-0043 dated 10 August 2020 under conditions indicated below:

/ x / Strictly in accordance with the approved itinerary.

/ / Cut short as explained below. Excess payment in the amount of
P_______ was refunded under O. R. No. ________ dated __________
/ / Extended as explained below, additional itinerary was submitted
/ / Other deviation as explained below.

Explanation or justifications:

Evidence of travel:
"Special Order, Certificate of Appearance, Certification of Expenses Not Requiring Receipts"

Respectfully submitted:

LEA J. GIMEDA
Name of Enumerator

On evidence and information of which I have the knowledge, the travel was actually undertaken.

Approved:

ARIEL T. FORTUITO
CSS
uiring Receipts"

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