Instructions in Filling out the Budget Accountability Report (BAR) Annex

A. Effective________, the revised Budget Accountability Report Annex shall be used and will serve as documentary
evidence for the program, projects and activities implemented by the Center.

B. The form shall be accomplished by the designated Focal Person or Program Coordinator, following the
instructions below:

ANNEX 1: LIST OF LEARNING SITE, SCHOOL FOR PRACTICAL AGRICULTURE AND FARM TOURISM SITE
1. NAME OF SITE: Indicate the complete name of site
2. TYPE OF SITE: Specify if it was developed as learning site, School for Practical Agriculture site, Farm
Tourism site
3. EXACT LOCATION: Indicate the barangay, municipality/city and province
4. NAME OF COOPERATOR: Indicate the last name, first name and middle name
5. DATE ESTABLISHED: Indicate the date when the site was established
6. FUND SOURCE: Indicate the source of fund
7. BRIEF DESCRIPTION: Indicate the total land area and commodities or technologies added/established in the
farm with ATI's assistance
8. REMARKS: Indicate the current status of the site

ANNEX 2: LIST OF FARM SITE VISITORS

1. NAME OF VISITOR: Indicate the last name, first name and middle name
2. ADDRESS OF VISITOR: Indicate the exact address of the visitor (brgy, municipality and province)
3. SEX: Specify the sex of the visitor (male or female)
4. FARM SITE VISITED: Indicate the name of the visited farm site
5. DATE VISITED: Indicate the date when the farm visited

ANNEX 3: LIST OF IEC MATERIALS DISSEMINATED

1. TITLE OF IEC MATERIALS: Specify the title of IEC Materials e.g. if it rice related indicate as Rice or if it corn
related indicate as Corn and so on
2. TYPE OF IEC MATERIALS: Indicate the type of IEC materials if it audio, video or printed materials
3. NO. OF IEC MATERIALS DISSEMINATED: Indicate the number of disseminated IEC materials
4. COVERED LOCATION OF RECIPIENT: Indicate the exact location where the IEC materials disseminated
(brgy, municipality and province)
5. DATE DISSEMINATED: Indicate the date when the IEC materials disseminated

ANNEX 4. LIST OF RECIPIENTS GIVEN INCENTIVES, GRANTS AND AWARDS

1. NAME OF RECIPIENT: Indicate the complete name of the recipient (last name, first name and middle name)

2. TYPE OF RECIPIENT: Specify the type of recipient (AEWs, RBO, Farmers etc.)
3. ADDRESS OF THE RECIPIENT: Indicate the complete address of the recipient (brgy, municipality and
province)
4. TYPE OF INCENTIVE: Specify the type of incentive if it scholarship, insurance, livelihood or award
5. FUND SOURCE: Indicate the source of fund
6. AMOUNT GRANTED: Indicate the amount granted to the recipient
7. DATE GRANTED: Indicate the date when the incentive granted to the recipient
8. REMARKS: Specify in the remarks the current status if it is on-going or completed

ANNEX 5. LIST OF EXTENSION RELATED R&D

1. TITLE OF POLICY RESEARCH: Indicate the title of the policy research
2. OBJECTIVE: Indicate the objective of the policy research
3. NAME OF THE PROPONENT: Indicate the name of the proponent (last name, first name and middle name)

4. EXPECTED OUTPUT: Indicate the expected of the policy research

5. DATE STARTED: Indicate the date when the policy research started (month/day/year)
6. DATE ENDED: Indicate the date when the policy research will end (month/day/year)
7. ACTUAL COST INCURRED: Indicate the actual cost of the policy research
8. FUND SOURCE: Indicate the source of fund
9. REMARKS: Specify in the remarks the current status if it is on-going or completed

ANNEX 6. LIST OF EXTENSION MANUAL

1. TITLE OF MANUAL: Indicate the title of the extension manual
2. BRIEF DESCRIPTION: Indicate the brief description of the extension manual (purpose)
3. NAME OF THE PROPONENT: Indicate the name of the proponent (last name, first name and middle name)

4. DATE ACCOMPLISHED: Indicate the date when the policy research will end (month/day/year)
5. REMARKS: Specify in the remarks the current status if it is on-going or completed

C. To meet the required deadline in the submission of reports to the CPMES-PPD, the cut-off date should be set
by the designated M&E Officer at the Center level and Central Office Division for strict compliance by those
concerned in the submission of reports.

D. The accomplished form shall be submitted to M&E Officer for validation. TCS I will affix his/her initial before
the approval of the Center Director

E. It shall be submitted to the Corporate Planning, Monitoring and Evaluation Section of Policy and Planning
Division (for ATI-CO) every three (3) working days of the succeeding month.
 Republic of the Philippines
Department of Agriculture
AGRICULTURAL TRAINING INSTITUTE-REGIONAL TRAINING CENTER MiMaRoPa
Barcenaga, Naujan, oriental Mindoro
Tel Nos: (02) 359-1967; 0917-843-2654; 0939-916-6473
Email: atibarcenaga@yahoo.com | URL: www.ati.da.gov.ph/mimaropa

ANNEX 1. LIST OF TECHNOLOGY DEMONSTRATION OR LEARNING SITES

Training Center: MiMaRoPa

EXACT LOCATION Name of Cooperators BRIEF DESCRIPTION

TYPE OF SITE (Pls
NO. NAME OF SITE specify if it was developed DATE ESTABLISHED FUND REMARKS
(month/date/year) SOURCE commodities or technologies
as LS. SPA or FT) Province Municipality Barangay Last Name First Name Middle Name Land area added/established in the farm
with ATI's assistance

Under development

TESDA-
Super M Bliss, Brgy. TWSP
School of Marfrancisco Scholarship
1 Science and LSA Or. Mindoro Pinamalayan ATIENZA MARLON ACERON Jan.21,2020 (Training 600sq.m Organic Fertilizer
Technology Pinamalayan for Work
Inc. SMSST Oriental,Mindoro Scholarship
Program)

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

Prepared by: Validated by: Approved by:

Focal Person M&E Officer Center Director

ATI-QF/PPD-33A1 Rev. 01 Effectivity Date: October 4, 2018 3 of 9

 Republic of the Philippines
Department of Agriculture
AGRICULTURAL TRAINING INSTITUTE-REGIONAL TRAINING CENTER MiMaRoPa
Barcenaga, Naujan, oriental Mindoro
Tel Nos: (02) 359-1967; 0917-843-2654; 0939-916-6473
Email: atibarcenaga@yahoo.com | URL: www.ati.da.gov.ph/mimaropa

ANNEX 2. Super M School of Science and Technology (SMSST), Inc. VISITORS

Training Center: MiMaRoPa

Name of Visitor Address of Visitors

No. Farm Site Visited Date Visited
Sex (M/F) (month/date/year)
Last Name First Name Middle Name Province Municipality Barangay

1 MATEO CRISOSTOMO C ORIENTAL MINDORO CALAPAN M SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21
2 REYMUNDO JHONEL 0 ORIENTAL MINDORO PINAMALAYAN MAR FRANCISCO M SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

3 DE LUNA ANGELO D ORIENTAL MINDORO PINAMALAYAN MAR FRANCISCO M SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

4 NATAL MARIELLE M ORIENTAL MINDORO PINAMALAYAN STA.RITA F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

5 CONDE CLINTON M ORIENTAL MINDORO GLORIA KAWIT M SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

6 BEDICO GISSELLE R ORIENTAL MINDORO PINAMALAYAN MAR FRANCISCO M SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

7 FUNELAS IVY A ORIENTAL MINDORO PINAMALAYAN MAR FRANCISCO F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

8 ANGANA CHRISTIAN F ORIENTAL MINDORO PINAMALAYAN MAR FRANCISCO F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

9 LUMAGBAS JOEL M ORIENTAL MINDORO PINAMALAYAN CALINGAG M SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

10 MALVAR ANNETTE ANN S ORIENTAL MINDORO GLORIA MALIGAYA F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

11 MADRIGAL ADELINA S ORIENTAL MINDORO PINAMALAYAN STA.RITA F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

12 VIDA RAMON VICENTE A ORIENTAL MINDORO SOCORRO ZONE IV M SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

13 MALANGIS SADEL R ORIENTAL MINDORO PINAMALAYAN ZONE II F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

14 MALIWANAG WENDELL ORIENTAL MINDORO PINAMALAYAN PILI M SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

15 LANOT VINA MAE S ORIENTAL MINDORO PINAMALAYAN STA.RITA F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

16 MONTESA CARMEL A ORIENTAL MINDORO PINAMALAYAN MAR FRANCISCO F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

17 MOSTACISA RODOLFO B ORIENTAL MINDORO PINAMALAYAN ZONE II M SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

18 VILLANUEVA MICHAEL ANGELO M ORIENTAL MINDORO PINAMALAYAN PILI M SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

19 ORNOS REMELYN M ORIENTAL MINDORO PINAMALAYAN MAR FRANCISCO F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

20 PANGANIBAN EDGARDO M ORIENTAL MINDORO PINAMALAYAN PILI M SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

21 PRIVADO FLORIEFEL S ORIENTAL MINDORO PINAMALAYAN PILI F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

22 PRIVADO GLADYS S ORIENTAL MINDORO PINAMALAYAN PILI F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

23 TUPAZ LADY LYN C ORIENTAL MINDORO GLORIA KAWIT F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

24 MAHAGUAY MARY ANN M ORIENTAL MINDORO PINAMALAYAN PANGGULAYAN F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21

ATI-QF/PPD-33A2 Rev. 01 Effectivity Date: October 4, 2018 4 of 9

ANNEX 2. Super M School of Science and Technology (SMSST), Inc. VISITORS
Training Center: MiMaRoPa

Name of Visitor Address of Visitors

No. Farm Site Visited Date Visited
Sex (M/F) (month/date/year)
Last Name First Name Middle Name Province Municipality Barangay

25 TUPAZ CARLA C ORIENTAL MINDORO GLORIA KAWIT F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21
26 MACABALI JORICA M ORIENTAL MINDORO PINAMALAYAN ZONE IV F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21
27 REYES SHIELLA A ORIENTAL MINDORO PINAMALAYAN STO.NINO F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/25/21
28 LANOT VINA MAE S ORIENTAL MINDORO PINAMALAYAN STA.RITA F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/26/21
29 MONTESA CARMEL A ORIENTAL MINDORO PINAMALAYAN MAR FRANCISCO F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/26/21
30 MOSTACISA RODOLFO B ORIENTAL MINDORO PINAMALAYAN ZONE II M SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/26/21
31 VILLANUEVA MICHAEL ANGELO M ORIENTAL MINDORO PINAMALAYAN PILI M SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/26/21
32 ORNOS REMELYN M ORIENTAL MINDORO PINAMALAYAN MAR FRANCISCO F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/26/21
33 MATEO CRISOSTOMO C ORIENTAL MINDORO CALAPAN M SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/26/21
34 REYMUNDO JHONEL 0 ORIENTAL MINDORO PINAMALAYAN MAR FRANCISCO M SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/26/21
35 DE LUNA ANGELO D ORIENTAL MINDORO PINAMALAYAN MAR FRANCISCO M SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/26/21
36 NATAL MARIELLE M ORIENTAL MINDORO PINAMALAYAN STA.RITA F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/26/21
37 CONDE CLINTON M ORIENTAL MINDORO GLORIA KAWIT M SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/26/21
38 PRIVADO GLADYS S ORIENTAL MINDORO PINAMALAYAN PILI F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/26/21
39 TUPAZ LADY LYN C ORIENTAL MINDORO GLORIA KAWIT F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/26/21
40 MAHAGUAY MARY ANN M ORIENTAL MINDORO PINAMALAYAN PANGGULAYAN F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/26/21
41 BEDICO GISSELLE R ORIENTAL MINDORO PINAMALAYAN MAR FRANCISCO M SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/26/21
42 FUNELAS IVY A ORIENTAL MINDORO PINAMALAYAN MAR FRANCISCO F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/26/21
43 ANGANA CHRISTIAN F ORIENTAL MINDORO PINAMALAYAN MAR FRANCISCO F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/26/21
44 LUMAGBAS JOEL M ORIENTAL MINDORO PINAMALAYAN CALINGAG M SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/26/21
45 MALVAR ANNETTE ANN S ORIENTAL MINDORO GLORIA MALIGAYA F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/26/21
46 MADRIGAL ADELINA S ORIENTAL MINDORO PINAMALAYAN STA.RITA F SUPER M SCHOOL OF SCIENCE AND TECHNOLOGY (SMSST), INC. 10/26/21

ATI-QF/PPD-33A2 Rev. 01 Effectivity Date: October 4, 2018 5 of 9

 Republic of the Philippines
Department of Agriculture
AGRICULTURAL TRAINING INSTITUTE-REGIONAL TRAINING CENTER MiMaRoPa
Barcenaga, Naujan, oriental Mindoro
Tel Nos: (02) 359-1967; 0917-843-2654; 0939-916-6473
Email: atibarcenaga@yahoo.com | URL: www.ati.da.gov.ph/mimaropa

ANNEX 3. LIST OF IEC MATERIALS DISSEMINATED

Training Center: Super M School of Science and Technology (SMSST), Inc.
Type of IEC materials Covered Location of Recipient
No. Title of IEC materials (video, audio or printed) No. of IEC materials Date Disseminated
disseminated (copies) Province Municipality Barangay (month/date/year)

1
2
3 Not Applicable
4
5
6
7
8
9
10
11

Prepared by: Reviwed by: Approved by:

MANILYN M. MIRHAN-TEJADA RUBEN P. JUGNO PAT ANDREW B. BARRIENTOS

Project Evaluation Officer I Training Cenetr Superintendent I Training Cenetr Superintendent I

ATI-QF/PPD-33A1 Rev. 03 Effectivity Date: October 4, 2018 6 of 9

 Republic of the Philippines
Department of Agriculture
AGRICULTURAL TRAINING INSTITUTE-REGIONAL TRAINING CENTER MiMaRoPa
Barcenaga, Naujan, oriental Mindoro
Tel Nos: (02) 359-1967; 0917-843-2654; 0939-916-6473
Email: atibarcenaga@yahoo.com | URL: www.ati.da.gov.ph/mimaropa

ANNEX 4. LIST OF RECIPIENTS GIVEN INCENTIVES, GRANTS AND AWARDS

Training Center: Super M School of Science and Technology (SMSST), Inc.
Name of Recipient Address of Recipient
Type of Incentives (Awards,
No. Type of Recipient Scholarship, Livelihood, Fund Source Amount granted Date granted Remarks
Last Name First Name Middle Name (AEWs/Farmers/RBOs,etc) Province Municipality Barangay Insurance) (month/date/year)

1 Not Applicable
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Prepared by: Validated by: Approved by:

Focal Person M&E Officer Center Director

ATI-QF/PPD-33A4 Rev. 01 Effectivity Date: October 4, 2018 7 of 9

 Republic of the Philippines
Department of Agriculture
AGRICULTURAL TRAINING INSTITUTE-REGIONAL TRAINING CENTER MiMaRoPa
Barcenaga, Naujan, oriental Mindoro
Tel Nos: (02) 359-1967; 0917-843-2654; 0939-916-6473
Email: atibarcenaga@yahoo.com | URL: www.ati.da.gov.ph/mimaropa

ANNEX 5. LIST OF EXTENSION RELATED R&D

Training Center: Super M School of Science and Technology (SMSST), Inc.

Name of Proponent Date

Started Date Completed Actual Cost Fund Remarks (On-
No. Title of Policy Research Objective/s Expected Output
Last Name First Name Middle Name (month/date/y (month/date/year) Incurred Source going/Completed
)
ear)

1
2
3
4 Not Applicable
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

Prepared by: Validated by: Approved by:

Focal Person M&E Officer Center Director

ATI-QF/PPD-33A5 Rev. 01 Effectivity Date: October 4, 2018 8 of 9

 Republic of the Philippines
Department of Agriculture
AGRICULTURAL TRAINING INSTITUTE-REGIONAL TRAINING CENTER MiMaRoPa
Barcenaga, Naujan, oriental Mindoro
Tel Nos: (02) 359-1967; 0917-843-2654; 0939-916-6473
Email: atibarcenaga@yahoo.com | URL: www.ati.da.gov.ph/mimaropa

ANNEX 6. LIST OF EXTENSION MANUAL

Training Center: Super M School of Science and Technology (SMSST), Inc.
Name of Proponent Date Accomplished
No. Title of Manual Brief Description/s Remarks
Last Name First Name Middle Name (month/date/year)

Not Applicable

Prepared by: Validated by: Approved by:

Focal Person M&E Officer Center Director

ATI-QF/PPD-33A6 Rev. 01 Effectivity Date: October 4, 2018 9 of 9