BORJA

Republic of the Philippines
Department of Health
CENTER FOR HEALTH DEVELOPMENT - Caraga
Butuan City
APPENDIX "A" No.____________________

Date: _________________
Name: NIEL H. NITUDA Position: Program Coordinator/MedTech II
Official Station: CHD - Caraga
Purpose: MEDICAL-TRAUMA RESPONSE TEAM POST IMPACT TD ODETTE
TIME MEANS OF
TOTAL
TRANSPORT
DATE PLACES TO BE TRANSPOR
ATION
ENCENTIVE AMOUNT
TATION
VISITED DEPARTURE ARRIVAL
December 18, 2021 DOH RO XII to PDOHO - Surigao del Norte 7:00 AM 10:00 AM RP 1,500.00 1,500.00
PDOHO - Surigao del Norte to Siargao Island 11:00 AM 1:00 PM
Siargao Island, Surigao del Norte 1:00 PM 5:00 PM
December 19 to 27, Still in Siargao Island, Surigao del Norte 8:00 AM 5:00 PM RP 13,500.00 13,500.00
2021
December 28, 2021 Siargao Island to Surigao City 11:00 AM 1:00 PM RP 750.00 750.00
Surigao City to Station (Butuan City) 3:00 PM 6:00 PM
Grand Total 15,750.00
I CERTIFY THAT: Prepared by:
1. I have reviewed the foregoing itinerary

2. The travel is necessary to the service NIEL H. NITUDA, RMT
3. The period covered is reasonable Program Coordinator/MedTech II
4. The expenses claimed are proper
Approved by:
ERNESTO E. PAREJA, MD, MPH

Chief, Local Health Support Division
Butuan City
APPENDIX "B"
CERTIFICATE OF TRAVEL COMPLETED
Regional Director
Caraga Regional Field Office No. XIII
Butuan City
Sir:
I certify that I have completed the travel strickly in accordance with the approved itinerary of travel.
Explanation / Justification :
_____________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Evidence of travel:
__________________ Data collected
__________________ Certificate of Appearance
__________________ Tickets
__________________ Feedback Report
_______________RSO
Respectfully submitted by:
NIEL H. NITUDA, RMT

Program Coordinator/MedTech II
On the service and information of which I have knowledge the travel was actually undertaken.

Butuan City
APPENDIX "A" No.____________________

Date: _________________
Name: MERLIZA ANN T. LUMACANG Position: Program Development Officer
TIME MEANS OF
TOTAL
TRANSPORT
ATION
ENCENTIVE AMOUNT
TATION
2021

2. The travel is necessary to the service MERLIZA ANN T. LUMACANG
3. The period covered is reasonable Program Development Officer
Approved by:

Butuan City
APPENDIX "B"
Regional Director
Butuan City
Sir:
_____________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Evidence of travel:
__________________ Data collected
__________________ Tickets
_______________RSO
MERLIZA ANN T. LUMACANG

Program Development Officer

Butuan City
APPENDIX "A" No.____________________

Date: _________________
Name: MARLON A. CAHAYON Position: Administrative Assistant II
TIME MEANS OF
TOTAL
TRANSPORT
ATION
ENCENTIVE AMOUNT
TATION
2021

2. The travel is necessary to the service MARLON A. CAHAYON
3. The period covered is reasonable Administrative Assistant II
Approved by:

Butuan City
APPENDIX "B"
Regional Director
Butuan City
Sir:
_____________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Evidence of travel:
__________________ Data collected
__________________ Tickets
_______________RSO
MARLON A. CAHAYON
Administrative Assistant II

Butuan City
APPENDIX "A" No.____________________

Date: _________________
Name: PHOEBIE RHANIE D. BUQUE Position: Health Promotion Officer II
TIME MEANS OF
TOTAL
TRANSPORT
ATION
ENCENTIVE AMOUNT
TATION
2021

2. The travel is necessary to the service PHOEBIE RHANIE D. BUQUE
3. The period covered is reasonable Health Promotion Officer II
Approved by:

Butuan City
APPENDIX "B"
Regional Director
Butuan City
Sir:
_____________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Evidence of travel:
__________________ Data collected
__________________ Tickets
_______________RSO
PHOEBIE RHANIE D. BUQUE

Health Promotion Officer II

Butuan City
APPENDIX "A" No.____________________

Date: _________________
Name: QUIRTZY NIÑA PANSACALA Position: Health Program Officer
TIME MEANS OF
TOTAL
TRANSPORT
ATION
ENCENTIVE AMOUNT
TATION
December 18,2021 DOH RO XII to PDOHO - Surigao del Norte 7:00 AM 10:00 AM RP 1,500.00 1,500.00
2021

2. The travel is necessary to the service QUIRTZY NIÑA PANSACALA
3. The period covered is reasonable Health Program Officer
Approved by:

Butuan City
APPENDIX "B"
Regional Director
Butuan City
Sir:
_____________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Evidence of travel:
__________________ Data collected
__________________ Tickets
_______________RSO
QUIRTZY NIÑA PANSACALA

Health Program Officer

Butuan City
APPENDIX "A" No.____________________

Date: _________________
Name: ROSA LEAH M. NAVARRO Position: Engineer
TIME MEANS OF
TOTAL
TRANSPORT
ATION
ENCENTIVE AMOUNT
TATION
2021

2. The travel is necessary to the service ENGR. ROSA LEAH M. NAVARRO
3. The period covered is reasonable Engineer
Approved by:

Butuan City
APPENDIX "B"
Regional Director
Butuan City
Sir:
_____________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Evidence of travel:
__________________ Data collected
__________________ Tickets
_______________RSO
ENGR. ROSA LEAH M. NAVARRO

Engineer

Butuan City
APPENDIX "A" No.____________________

Date: _________________
Name: DIOSCORO M. NAVARRO JR. Position: Engineer III
TIME MEANS OF
TOTAL
TRANSPORT
ATION
ENCENTIVE AMOUNT
TATION
2021

2. The travel is necessary to the service ENGR. DIOSCORO M. NAVARRO JR.
3. The period covered is reasonable Engineer III
Approved by:

Butuan City
APPENDIX "B"
Regional Director
Butuan City
Sir:
_____________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Evidence of travel:
__________________ Data collected
__________________ Tickets
_______________RSO
ENGR. DIOSCORO M. NAVARRO JR.

Engineer III

Butuan City
APPENDIX "A" No.____________________

Date: _________________
Name: CLEEFORD S. SUAREZ Position: Dengue Vector Control Officer
TIME MEANS OF
TOTAL
TRANSPORT
ATION
ENCENTIVE AMOUNT
TATION
2021

2. The travel is necessary to the service CLEEFORD S. SUAREZ
3. The period covered is reasonable Dengue Vector Control Officer
Approved by:

Butuan City
APPENDIX "B"
Regional Director
Butuan City
Sir:
_____________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Evidence of travel:
__________________ Data collected
__________________ Tickets
_______________RSO
CLEEFORD S. SUAREZ
Dengue Vector Control Officer

Butuan City
APPENDIX "A" No.____________________

Date: _________________
Name: RAYE CASSEY B. GABUTIN Position: Malaria Surveillance Officer
TIME MEANS OF
TOTAL
TRANSPORT
ATION
ENCENTIVE AMOUNT
TATION
2021

2. The travel is necessary to the service RAYE CASSEY B. GABUTIN, RN
3. The period covered is reasonable Malaria Surveillance Officer
Approved by:

Butuan City
APPENDIX "B"
Regional Director
Butuan City
Sir:
_____________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Evidence of travel:
__________________ Data collected
__________________ Tickets
_______________RSO
RAYE CASSEY B. GABUTIN, RN

Malaria Surveillance Officer

Butuan City
APPENDIX "A" No.____________________

Date: _________________
Name: VIMA T. BERMOY Position: Nurse I
TIME MEANS OF
TOTAL
TRANSPORT
ATION
ENCENTIVE AMOUNT
TATION
2021

2. The travel is necessary to the service VIMA T. BERMOY, RN
3. The period covered is reasonable Nurse I
Approved by:

Butuan City
APPENDIX "B"
Regional Director
Butuan City
Sir:
_____________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Evidence of travel:
__________________ Data collected
__________________ Tickets
_______________RSO
VIMA T. BERMOY, RN
Nurse I

Butuan City
APPENDIX "A" No.____________________

Date: _________________
Name: LEVY S. MONTAÑEZ Position: Nurse I
TIME MEANS OF
TOTAL
TRANSPORT
ATION
ENCENTIVE AMOUNT
TATION
2021

2. The travel is necessary to the service LEVY S. MONTAÑEZ, RN
3. The period covered is reasonable Nurse I
Approved by:

Butuan City
APPENDIX "B"
Regional Director
Butuan City
Sir:
_____________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Evidence of travel:
__________________ Data collected
__________________ Tickets
_______________RSO
LEVY S. MONTAÑEZ, RN
Nurse I

Butuan City
APPENDIX "A" No.____________________

Date: _________________
Name: DORCAS G. DINHAYAN Position: Statistician III
TIME MEANS OF
TOTAL
TRANSPORT
ATION
ENCENTIVE AMOUNT
TATION
2021

2. The travel is necessary to the service DORCAS G. DINHAYAN
3. The period covered is reasonable Statistician III
Approved by:

Butuan City
APPENDIX "B"
Regional Director
Butuan City
Sir:
_____________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Evidence of travel:
__________________ Data collected
__________________ Tickets
_______________RSO
DORCAS G. DINHAYAN
Statistician III

Butuan City
APPENDIX "A" No.____________________

Date: _________________
Name: GLEE D. VALENZONA Position: Medical Officer IV
TIME MEANS OF
TOTAL
TRANSPORTA
TION
ENCENTIVE AMOUNT
TATION
2021

2. The travel is necessary to the service GLEE D. VALENZONA, MD
3. The period covered is reasonable Medical Officer IV
Approved by:

Butuan City
APPENDIX "B"
Regional Director
Butuan City
Sir:
_____________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Evidence of travel:
__________________Data collected
__________________Certificate of Appearance
__________________Tickets
__________________Feedback Report
_______________RSO
GLEE D. VALENZONA, MD
Medical Officer IV

TRAVELLING EXPENSES PAYROLL
WE HEREBY ACKNOWLEDGE to reimburse the sum therein specified opposite being in full payment for our expenses incurred for Travelling Expenses
and Per diem while on official business from December 18 to 28, 2021, in Siargao Island, Surigao del Norte.
NO.
NAME DESIGNATION AMOUNT ACCOUNT NO. SIGNATURE REMARK
1 Glee D. Valenzona, MD Medical Officer IV 15,750.00

2 Dorcas G. Dinhayan Statistician III 15,750.00
3 Levy S. Montañez Nurse I 15,750.00
4 Vima T. Bermoy Nurse I 15,750.00
5 Raye Cassey B. Gabutin Malaria Surveillance Officer 15,750.00
6 Cleeford S. Suarez Dengue Surveillance Officer 15,750.00
7 Dioscoro M. Navarro Jr. Engineer III 15,750.00
8 Rosa Leah M. Navarro Engineer 15,750.00
9 Quirtzy Niña Pansacala Health Program Officer 15,750.00
10 Phoebi Rhanie D. Buque Health Promotion Officer II 15,750.00
11 Marlon A. Cahayon Administrative Assistant II 15,750.00
12 Merliza Ann T. Lumacang Program Development Officer 15,750.00
TOTAL 189,000.00
1) I CERTIFY on my official oath that the above expenses 2) APPROVED, payable from appropriation 3) CERTIFIED:
having been incurred under my authority in the interest for by authority of the Secretary of Health 1) Adequate available funds in the amount of __________
of the public service. 2) Properly approved
3) Supported by documents appearing leagal and
and proper list attached.
MARYFE N. ROSALES, LPT ERNESTO E. PAREJA, MD, MPH JAY RYAN F. VILLASURDA, CPA
Health Program Researcher Chief, Local Health Support Division Accountant III
Appendix 32
Republic of the Philippines Fund Cluster :

DEPARTMENT OF HEALTH - RO XIII
Date :
DISBURSEMENT VOUCHER DV No. :
Mode of MDS Check Commercial Check ADA Others (Please specify)

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee GLEE D. VALENZONA, et al.
Address Butuan City

Responsibility
Particulars MFO/PAP Amount
Center
To facilitate the Cash Advance of Siargao Island Health
Response Team (Composite as Medical, WASH, MHPSS &
Nutrition) while on official business as per supporting papers
hereto attached in the amount of . . . . . . . . . . . . . . . . . . . . . . . 189,000.00
. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . .
Amount Due 189,000.00

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.
ERNESTO E. PAREJA, MD., MPH

MO V/Chief LHSD
B. Accounting Entry:
Account Title UACS Code Debit Credit
C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Supp
proper
Signature Signature
Printed Name Printed Name

JAY RYAN F. VILLASURDA, CPA CESAR C. CASSION, MD, MPH, CESO IV
Accountant III Director IV
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date : Bank Name & Account Number:
No. :
Date : Printed Name: Date
Signature :
Official Receipt No. & Date/Other Documents
92
OBLIGATION REQUEST AND STATUS Appendix 11
` Serial No.
REGIONAL OFFICE XIII :
Butuan City Date :
Pizarro Street, Corner Narra Road
Tel.# (085) 342-52-08/342-5667/FAX –225-2970 Fund Clust
Payee GLEE D. VALENZONA, et.al
Office DOH CHD CARAGA

Address Butuan City
UACS
Responsibility Center Particulars MFO/PAP Object Amount
Code
To facilitate the Cash Advance of Siargao Island Health

Response Team (Composite as Medical, WASH, MHPSS
& Nutrition) while on official business as per supporting 189,000.00
papers hereto attached in the amount of . . . . . . . . . . . . . . .
........................
Total 189,000.00
A. B.
Certified: Charges to appropriation/alloment are 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: ERNESTO E. PAREJA, MD., MPH Printed Nam JEAN AGANAP-PINGAL, MPA
Position : Division Chief-LHS Position Administrative Officer V/Budget
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)
12/29/2021 189,000.00

BORJA

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Republic of the Philippines

APPENDIX "A" No.____________________

Grand Total 15,750.00

I CERTIFY THAT: Prepared by:

1. I have reviewed the foregoing itinerary

ERNESTO E. PAREJA, MD, MPH

CERTIFICATE OF TRAVEL COMPLETED

Respectfully submitted by:

NIEL H. NITUDA, RMT

ERNESTO E. PAREJA, MD, MPH

APPENDIX "A" No.____________________

Grand Total 15,750.00

I CERTIFY THAT: Prepared by:

1. I have reviewed the foregoing itinerary

ERNESTO E. PAREJA, MD, MPH

CERTIFICATE OF TRAVEL COMPLETED

Respectfully submitted by:

MERLIZA ANN T. LUMACANG

ERNESTO E. PAREJA, MD, MPH

APPENDIX "A" No.____________________

Grand Total 15,750.00

I CERTIFY THAT: Prepared by:

1. I have reviewed the foregoing itinerary

ERNESTO E. PAREJA, MD, MPH

CERTIFICATE OF TRAVEL COMPLETED

Respectfully submitted by:

ERNESTO E. PAREJA, MD, MPH

APPENDIX "A" No.____________________

Grand Total 15,750.00

I CERTIFY THAT: Prepared by:

1. I have reviewed the foregoing itinerary

ERNESTO E. PAREJA, MD, MPH

CERTIFICATE OF TRAVEL COMPLETED

Respectfully submitted by:

PHOEBIE RHANIE D. BUQUE

ERNESTO E. PAREJA, MD, MPH

APPENDIX "A" No.____________________

Grand Total 15,750.00

I CERTIFY THAT: Prepared by:

1. I have reviewed the foregoing itinerary

ERNESTO E. PAREJA, MD, MPH

CERTIFICATE OF TRAVEL COMPLETED

Respectfully submitted by:

QUIRTZY NIÑA PANSACALA

ERNESTO E. PAREJA, MD, MPH

APPENDIX "A" No.____________________

Grand Total 15,750.00

I CERTIFY THAT: Prepared by:

1. I have reviewed the foregoing itinerary

ERNESTO E. PAREJA, MD, MPH

CERTIFICATE OF TRAVEL COMPLETED

Respectfully submitted by:

ENGR. ROSA LEAH M. NAVARRO

ERNESTO E. PAREJA, MD, MPH

APPENDIX "A" No.____________________

Grand Total 15,750.00

I CERTIFY THAT: Prepared by:

1. I have reviewed the foregoing itinerary

ERNESTO E. PAREJA, MD, MPH

CERTIFICATE OF TRAVEL COMPLETED

Respectfully submitted by:

ENGR. DIOSCORO M. NAVARRO JR.

ERNESTO E. PAREJA, MD, MPH

Signature : _____ Signature

Date : _______ Date