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Republic of the Philippines

UNIVERSITY OF EASTERN PHILIPPINES


University Town, Northern Samar, Philippines
Web: uep.edu.ph; Email: ueppres06@gmail.com
CRN: ___________

Claim for:
SERVICE REPORT
__ Salary
For the month of _________________-
__ Overtime
Official hours for arrival and departure:
__ Excess Load
Regular days: Morning ________ Afternoon _________ Evening ________ __ Honorarium
Weekends: Morning ________ Afternoon _________ Evening ________ __ Vacation Service Cred

I, _________________________________________, hereby certify on my honor and official oath that the


following is a true and correct report of services I have rendered as ___________________ assigned at
____________________________, for the month above-indicated.
I further certify that my absences due to leave and/or travel are official per attached copy of approved leave,
travel orders, vehicle trip ticket/s, and/or certificate/s of appearance.

MORNING AFTERNOON EVENING TARDY UNDERTIME REMARKS


DAY (Leave/Travel/Others)
Departur Hour Min
Arrival Arrival Departure Arrival Departure Hours Mins
e s s
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
No. of Days/Hours of Services Rendered:
TOTAL
____________
Submitted this __ day of __________ at the University of Eastern Philippines, University Town, Northern Samar.

Prepared and Submitted by: Verified as to prescribed office hours:

Effectivity Date: July 20, 2018 Document Code: UEP-T-29CAO-003 Version No.: v1 Page 1 of 2
This document is a sole property of the UNIVERISTY OF EASTERN PHILIPPINES (UEP).
This original copy of this Document is with the Document Information Controller/Records Office.
Any disclosure, reproduction or use is strictly prohibited except with permission from UEP.
Republic of the Philippines
UNIVERSITY OF EASTERN PHILIPPINES
University Town, Northern Samar, Philippines
Web: uep.edu.ph; Email: ueppres06@gmail.com

SERVICE REPORT
For the month of _________________-

Signature over Printed Name Signature over Printed Name of Supervisor

Effectivity Date: July 20, 2018 Document Code: UEP-T-29CAO-003 Version No.: v1 Page 1 of 2
This document is a sole property of the UNIVERISTY OF EASTERN PHILIPPINES (UEP).
This original copy of this Document is with the Document Information Controller/Records Office.
Any disclosure, reproduction or use is strictly prohibited except with permission from UEP.

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