Appendix 44

LIQUIDATION REPORT Serial No.: _________________

Period Covered ________________ Date: _____________________

Entity Name : ____________________________________________ Responsibility Center Code:

Fund Cluster : Regular Agency Fund __________________________

PARTICULARS AMOUNT

To Liquidate Cash Advance granted to ______(school)__________

for ______(purpose of CA)_____________ in the amount of ...

TOTAL AMOUNT SPENT

AMOUNT OF CASH ADVANCE PER DV NO.______DTD. ______
AMOUNT REFUNDED PER OR NO. ________DTD. ___________
AMOUNT TO BE REIMBURSED
A Certified: Correctness of the Certified: Purpose of travel / Certified: Supporting documents
above data cash advance duly accomplished complete and proper

________________________ ________________________ GERLIE V. CAÑAS

Signature over Printed Name Signature over Printed Name Signature over Printed Name
School Head Asst. Schools Division Superintendent Division Accountant

B C JEV No.: ___________________

Date: ______________________ Date: _____________________ Date: _____________________
 Appendix 37

CASH IN BANK REGISTER

Sheet No.: ____________________________________

Entity Name: ____________________________________________ Name of Disbursing Officer: _____________________
Sub-Office/District/Division: ________________________________ Station: ______________________________________
Municipality/City/Province:_________________________________ Bank : _______________________________________
Fund Cluster :____________________________________________ Location: _____________________________________

BREAKDOWN OF WITHDRAWALS/PAYMENTS
CASH IN BANK
MAINTENANCE AND OTHER OPERATING EXPENSES OTHERS
Date Check No. Payee Particulars Travelling Office Electricity Transportation
Training Expenses Janitorial
Withdrawals/ Expenses- Supplies and Delivery
Deposits Balance Expenses Services TOTAL Due to BIR
Payments Local Expenses Expenses
(50201010) (50201020) (50203010) (50201010) (50299040) (50212020)
-
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
TOTALS - - - - - - - - - - - - - - -
RECEIVED BY:
PREPARED BY: CERTIFIED CORRECT:

_______________________ Ma. Susana C. Benosa Gerlie V. Cañas

Signature over Printed Name Signature over Printed Name Signature over Printed Name Signature over Printed Name
Disbursing Officer School Head Senior Bookkeeper Division Accountant
Date: ___________ Date: ___________ Date: ___________ Date: ___________
 CASH IN BAN

Entity Name: ____________________________________________

Sub-Office/District/Division: ________________________________
Municipality/City/Province:_________________________________
Fund Cluster :____________________________________________

CASH IN BANK

Check
Date Payee Particulars
No.
Deposits

4/18/16 San Roque ES Download for April 2016 20,000.00

4/18/16 0001 Casureco II Payment of electric bill for the month of March 2016
102

4/19/16 0002 Pili Water District Payment of water bill for the month of March 2016
0003 CANCELLED
4/20/16 0004 Juan dela Cruz Reimbursement of traveling expense
5/4/16 0005 BIR Remittance of taxes withheld

TOTALS -

PREPARED BY: CERTIFIED CORRECT:

____________________
Signature over Printed Name Signature over Printed Nam
Disbursing Officer School Head
Date: ___________ Date: ___________
 CASH IN BANK REGISTER

Sheet No.: ___________________________________

Name of Disbursing Officer: ___________________
Station: _____________________________________
Bank : _______________________________________
Location: ____________________________________

BREAKDOWN OF WITHDRAWALS/PAYMENTS
CASH IN BANK
MAINTENANCE AND OTHER OPERATING EXPENSES
Travelling Office Electricity
Training Expenses Water Janitorial
Withdrawals/ Expenses- Supplies
Balance Expenses Expenses Services
Payments Local Expenses
(50201010) (50201020) (50203010) (50201010) (50201020) (50212020)

590.00 19,410.00 600.00

195.00 19,215.00 200.00

400.00

- - 400.00 - - 600.00 200.00 -

CERTIFIED CORRECT: RECEIVED BY:

_______________________ ___________
___________
Signature over Printed Name Signature over Printed Name Signature over Printed Nam
__
School Head Senior Bookkeeper Division Accountant
Date: ___________ Date: ___________ Date: ___________
 Appendix 37

_____________________
_____________________
_____________________
_____________________
_____________________

MENTS
ES OTHERS

TOTAL Due to BIR

600.00 (10.00)
200.00 (5.00)
-
400.00
- 15.00
-
-
-
-
-

1,200.00 -

gnature over Printed Name

ivision Accountant
ate: ___________