Appendix 67

REPORT OF ACCOUNTABILITY FOR ACCOUNTABLE FORMS

For the month of December 2016

Entity Name : SIRUMA NATIONAL HIGH SCHOOL Fund Cluster : 01101101

Accountable Forms Beginning Balance Receipt Issue Ending Balance
Face Inclusive Serial Nos. Inclusive Serial Nos. Inclusive Serial Nos. Inclusive Serial Nos.
Name of Form Number Quantity Quantity Quantity Quantity
Value From To From To From To From To
A. WITH FACE VALUE

B. WITHOUT FACE VALUE

0042-1230-99
Downloading Current Account 87 1678814 1678900 13 1678814 1678826 74 1678827 1678900

CERTIFICATION

I hereby certify that the foregoing is a true statement of all accountable forms received,
issued and transferred by me during the period above-stated and that the beginning and ending balances are correct.

KEVIN PATRICK S. PRADES, Disbursing Officer II

Signature over Printed Name of the Accountable Officer
 Appendix 35

REPORT OF CHECKS ISSUED

Period Covered: FEBRUARY 2016

Entity Name : SIRUMA NATIONAL HIGH SCHOOL

Fund Cluster : Report No.: 2016-02-001
Bank Name/Account No. : LBP-NAGA (0042-1230-99) Sheet No.: 1

Check ORS/BU Responsibility UACS Object

DV/Payroll No. Payee Nature of Payment Amount
Date Serial No. RS No. Center Code Code

2/12/2016 1566572 2016-02-001 CASURECO II 5020402000 PAYMENT FOR ELECTRIC BILL DEC. 2015 & JAN. 2016 3,261.75
2/12/2016 1566573 2016-02-002 DOMINICK AZANA 5021203000 PAYMENT FOR GENERAL SERVICES RENDERED JANUARY 2016 4,000.00
2/12/2016 1566574 2016-02-003 NELSON LA MADRID 5021202000 PAYMENT FOR GENERAL SERVICES RENDERED JANUARY 2016 4,000.00
2/12/2016 1566575 2016-02-004 CHICKY BELANGEL 5020101000 REIMBURSEMENT FOR TEV JANUARY 25-27, 2016 1,900.00
2/12/2016 1566576 2016-02-005 ARVIN ATOLE 5020101000 REIMBURSEMENT FOR TEV JANUARY 25-27, 2016 1,900.00
2/12/2016 1566577 2016-02-006 SHARON HABABAG 5020101000 REIMBURSEMENT FOR TEV & TRAINING EXPENSE JANUARY 27-29, 2016 4,440.00
2/12/2016 1566578 2016-02-007 KEVIN PATRICK PRADES 5020101000 REIMBURSEMENT FOR TEV JANUARY 2016 3,866.05
2/29/2016 1566579 2016-02-008 DOMINICK AZANA 5021203000 PAYMENT FOR GENERAL SERVICES RENDERED FEBRUARY 2016 4,000.00
2/29/2016 1566580 2016-02-009 NELSON LA MADRID 5021202000 PAYMENT FOR GENERAL SERVICES RENDERED FEBRUARY 2016 4,000.00
2/29/2016 1566581 2016-02-010 ELTY BENAVIDEZ 5021299000 PAYMENT FOR GENERAL SERVICES RENDERED FEBRUARY 2016 4,000.00
2/29/2016 1566582 2016-02-011 UPGRADE CENTRAL 5020301001 PAYMENT FOR THE PURCHASE OF NETBOOK/LAPTOP 12,943.80
2/29/2016 1566583 2016-02-012 3GX SOLUTIONS 5020301001 PAYMENT FOR THE PURCHASE OF BOTTOMLESS PRINTER W/ SCANNER 7,567.00
2/29/2016 1566584 2016-02-013 LAND BANK OF THE PHILIPPINES FAO: BIR 2020101000 PAYMENT FOR INCOME TAX WITHHELD 1,110.10
2/29/2016 1566585 2016-02-014 LAND BANK OF THE PHILIPPINES FAO: BIR 2020101000 PAYMENT FOR EXPANDED VALUE ADDED TAX WITHHELD 218.20
2/29/2016 1566586 2016-02-015 LEO BOLALIN 5020101000 REIMBURSEMENT FOR TEV DATED JANUARY 4-9, 2016 3,640.00
2/29/2016 1566587 2016-02-016 KEVIN PATRICK PRADES 5020101000 REIMBURSEMENT FOR TEV FEBRUARY 5, 2016 974.35

CERTIFICATION
I hereby certify on my official oath that this Report of Checks Issued in (1) one sheet(s) is a full, true and correct
statement of all checks issued by me during the period stated above for which Check Nos.1566572 to 1566587 inclusive,
were actually issued by me in payment for obligations shown in the attached disbursement vouchers/payroll.

KEVIN PATRICK S. PRADES

Name and Signature of Disbursing Officer/Cashier

DISBURSING OFFICER II
Official Designation

Date
 Appendix ______

CHECK DISBURSEMENTS RECORD

Agency SIRUMA NATIONAL HIGH SCHOOL

Fund Sheet No. 2016-02-001

KEVIN PATRICK S. PRADES DISBURSING OFFICER II SIRUMA NATIONAL HS

Accountable Officer Official Designation Station
Check
NCA Received/ Checks Bank/NCA
Date Date Name of Payee UACS Code Nature of Payment
No. Deposit Made Issued Balance
Released
SIRUMA NHS/LEO B. MOOE DOWNLOAD FOR JANUARY&
BOLALIN FEBRUARY 2016 61,821.25 61,821.25
PAYMENT FOR ELECTRIC BILL DEC.
02/12/16 1566572 02/15/16 CASURECO II 5020402000 2015 & JAN. 2016 3,261.75 58,559.50
PAYMENT FOR SECURITY SERVICES
02/12/16 1566573 02/12/16 DOMINICK AZANA 5021203000 RENDERED JANUARY 2016 4,000.00 54,559.50
NELSON LA PAYMENT FOR JANITORIAL SERVICES
02/12/16 1566574 02/12/16 MADRID 5021202000 RENDERED JANUARY 2016 4,000.00 50,559.50
REIMBURSEMENT FOR TEV JANUARY
02/12/16 1566575 02/12/16 CHICKY BELANGEL 5020101000 25-27, 2016 1,900.00 48,659.50
REIMBURSEMENT FOR TEV JANUARY
02/12/16 1566576 02/12/16 ARVIN ATOLE 5020101000 25-27, 2016
REIMBURSEMENT FOR TEV & 1,900.00 46,759.50
TRAINING EXPENSE JANUARY 27-29,
02/12/16 1566577 02/12/16 SHARON HABABAG 5020101000 2016 4,440.00 42,319.50
KEVIN PATRICK REIMBURSEMENT FOR TEV JANUARY
02/12/16 1566578 02/12/16 PRADES 5020101000 2016 3,866.05 38,453.45
PAYMENT FOR SECURITY SERVICES
02/29/16 1566579 03/02/16 DOMINICK AZANA 5021203000 RENDERED FEBRUARY 2016 4,000.00 34,453.45
NELSON LA PAYMENT FOR JANITORIAL SERVICES
02/29/16 1566580 03/02/16 MADRID 5021202000 RENDERED FEBRUARY 2016 4,000.00 30,453.45
PAYMENT FOR GENERAL SERVICES
02/29/16 1566581 03/02/16 ELTY BENAVIDEZ 5021299000 RENDERED FEBRUARY 2016 4,000.00 26,453.45
UPGRADE PAYMENT FOR THE PURCHASE OF
02/29/16 1566582 02/29/16 CENTRAL 5020301001 NETBOOK/LAPTOP 12,943.80 13,509.65
PAYMENT FOR THE PURCHASE OF
02/29/16 1566583 02/29/16 LAND
3GX SOLUTIONS
BANK OF THE 5020301001 BOTTOMLESS PRINTER W/ SCANNER 7,567.00 5,942.65
PHILIPPINES FAO: PAYMENT FOR INCOME TAX
02/29/16 1566584 03/01/16 LAND
BIR BANK OF THE 2020101000 WITHHELD 1,110.10 4,832.55
PHILIPPINES FAO: PAYMENT FOR EXPANDED VALUE
02/29/16 1566585 03/01/16 BIR 2020101000 ADDED TAX WITHHELD 218.20 4,614.35
REIMBURSEMENT FOR TEV DATED
02/29/16 1566586 03/04/16 LEO BOLALIN 5020101000 JANUARY 4-9, 2016 3,640.00 974.35
KEVIN PATRICK REIMBURSEMENT FOR TEV
02/29/16 1566587 03/04/16 PRADES 5020101000 FEBRUARY 5, 2016 974.35 -

CERTIFICATION

I hereby certify that the foregoing is a correct and complete record of all checks issued by me in my capacity as Disbursing Officer II
of SIRUMA NATIONAL HIGH SCHOOL during the period from FEBRUARY 12, 2016 to FEBRUARY 29, 2016, inclusives, as indicated in the corresponding columns.

KEVIN PATRICK S. PRADES

Name and Signature

Date
 REPORT OF CANCELLED CHECK(S)-MOOE
Siruma National High School
Poblacion, Siruma, Camarines Sur

February 28, 2016

Report No. : 16-02-001

Bank Name/Account No.:LBP-Naga/0042-1230-99
DATE CHECK
Payee Amount Date Cancelled ACIC # Remarks
REPORTED Date Number PARTICULAR

NO CANCELLED CHECKS FOR THIS MONTH

KEVIN PATRICK S. PRADES

Disbursing Officer II
02/28/16

RECEIVED BY: DIANA GLENDA T. REBULADO

SENIOR BOOKKEEPER

DATE:
 REPORT OF SPOILED CHECK(S)-MOOE
Siruma National High School
Poblacion, Siruma, Camarines Sur

February 28, 2016

Report No. : 16-02-001

Bank Name/Account No.:LBP-Naga/0042-1230-99
CHECK
Payee Amount
Date Number
NO SPOILED CHECKS FOR THIS MONTH

KEVIN PATRICK S. PRADES

Disbursing Officer II
February 28, 2016

RECEIVED BY: DIANA GLENDA T. REBULADO

SENIOR BOOKKEEPER

DATE:
 REPORT OF STALED CHECK(S)-MOOE
Siruma National High School
Poblacion, Siruma, Camarines Sur

February 28, 2016

Report No. : 16-02-001

Bank Name/Account No.:LBP-Naga/0042-1230-99
DATE CHECK
Payee Amount REMARKS
STALED Date Number
NO STALED CHECKS FOR THIS MONTH

KEVIN PATRICK S. PRADES

Disbursing Officer II
February 28, 2016

RECEIVED BY: DIANA GLENDA T.R EBULADO

SENIOR BOOKKEEPER

DATE: