Adelo R. Borja: Appendix "A"

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

Date: _________________
Name: ADELO R. BORJA Position: Admin. Aide I V
Official Station: CHD - Caraga
Purpose: BAYANIHAN BAKUNAHAN VACCINATION TEAM DEPLOYMENT
MEANS
TIME OF TRANSP TOTAL
ENCENTIV
DATE PLACES TO BE TRANSP ORTATIO AMOUNT
E
VISITED DEPARTURE ARRIVAL ORTATIO N
N
November 23,2021 DOH RO XII to Agusan Del Sur PDOHO 7:00 AM 10:00 AM
PDOHO to Vaccination Area 11:00 AM 5;00 pm RP 1,500.00 1,500.00
November 24 to
December 3, 2021 Still in Agusan Del Sur 8:00 AM 5:00 PM RP 15,000.00 15,000.00
December 4, 2021 AGUSAN Del Sur PDOHO to Butuan City 11:00 AM 1:00 PM RP 750.00 750.00
Grand Total 17,250.00
I CERTIFY THAT: Prepared by:
1. I have reviewed the foregoing itinerary

2. The travel is necessary to the service ADELO R. BORJA
3. The period covered is reasonable Admin. AideIV
4. The expenses claimed are proper
Approved by:
ERNESTO E. PAREJA,MD,MPH
LHSD CHIEF
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:
ADELO R. BORJA
Admin AideIV
On the service and information of which I have knowledge the travel was actually undertaken.
ERNESTO E. PAREJA, MD,MPH

LSHD SHIEF
Butuan City
APPENDIX "A" No.____________________

Date: _________________
Name: Miko H. Espiritu Position: Nurse II
MEANS
ENCENTIV
E
N
November 23,2021 DOH RO XIII to Surigao City - PDOHO 7:00 AM 10:00PM
PDOHO to Surigao City Gym ( vaccination area) 11:00 AM 11:15 AM RP 1,500.00 1,500.00
November 24 to
December 3, 2021 still in Surigao City -PDOHO 8:00 AM 6:00 pm RP 15,000.00 15,000.00
December 4, 2021 Surigao City gym - Butuan City 11:00 AM 1:00 PM RP 750.00 750.00
Surigao City to Butuan City

2. The travel is necessary to the service MIKO H. ESPIRITU
3. The period covered is reasonable Nurse II
Approved by:
MARY GRACE O. LEOPARDAS, MD

Infectious Cluster Head/Medical Officer III
Butuan City
APPENDIX "B"
Regional Director
Butuan City
Sir:
_____________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Evidence of travel:
__________________ Data collected
__________________ Tickets
_______________RSO
MIKO H. ESPIRITU
Nurse II

Butuan City
APPENDIX "A" No.____________________

Date: _________________
Name: CLEEFORD S. SUAREZ Position: Admin. Aide IV
MEANS
ENCENTIV
E
N
November 23,2021 DOH RO XIII to Surigao City - PDOHO 7:00 AM 10:00PM
PDOHO to Surigao City Gym ( vaccination area) 11:00 AM 11:15 AM RP 1,500.00 1,500.00
November 24 to
December 3, 2021 still in Surigao City -PDOHO 8:00 AM 6:00 pm RP 15,000.00 15,000.00
December 4, 2021 Surigao City gym - Butuan City 11:00 AM 1:00 PM RP 750.00 750.00
Surigao City to Butuan City

2. The travel is necessary to the service CLEEFORD S. SUAREZ
3. The period covered is reasonable Admin Assistant IV
Approved by:

Butuan City
APPENDIX "B"
Regional Director
Butuan City
Sir:
_____________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Evidence of travel:
__________________ Data collected
__________________ Tickets
_______________RSO
CLEEFORD S. SUAREZ
Admin Assistant 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 March 22 to 26, 2020, in Brgy. New Tubigon, Sibagat, Agusan del Sur
NO.
NAME DESIGNATION AMOUNT ACCOUNT NO. SIGNATURE REMARK
1 Cleeford S. Suarez Admin. Aide IV 17,250.00

2 Miko H. Espiritu Nurse 17,250.00
3 Maria Cristina Iligan Admin. Aide IV 17,250.00
TOTAL 51,750.00
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.
MARY GRACE O LEOPARDAS,MD ERNESTO E. PAREJA, MD, MPH JAY RYAN F. VILLASURDA, CPA
Head, Infectious Cluster 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 JONATHAN R. BASADRE, et al.
Address Butuan City

Responsibility
Particulars MFO/PAP Amount
Center
13-001-03-00016-
03-09
To LIQUIDATE the Cash advance of Surigao City Medical /
Vaccination team while on official business as per supporting
papers hereto attached in the amount of . . . . . . . . . . . . . . . . . 51,750.00
......................
Amount Due 51,750.00

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 JOSE R. LLACUNA,JR.,MD,MPH,CESO III
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 CLEEFORD S. SUAREZ, et., Al.
Office DOH CHD CARAGA

Address Butuan City
UACS
Responsibility Center Particulars MFO/PAP Object Amount
Code
To LIQUIDATE the Cash advance of Surigao City

Medical / Vaccination team while on official business as
13-001-03-00016-03-09 51,750.00
per supporting papers hereto attached in the amount of . . .
....................................
Total 51,750.00
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 51,750.00

Adelo R. Borja: Appendix "A"

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Adelo R. Borja: Appendix "A"

Uploaded by

Copyright:

Available Formats

Republic of the Philippines

APPENDIX "A" No.____________________

Grand Total 17,250.00

I CERTIFY THAT: Prepared by:

1. I have reviewed the foregoing itinerary

CERTIFICATE OF TRAVEL COMPLETED

Respectfully submitted by:

ERNESTO E. PAREJA, MD,MPH

APPENDIX "A" No.____________________

Grand Total 17,250.00

I CERTIFY THAT: Prepared by:

1. I have reviewed the foregoing itinerary

MARY GRACE O. LEOPARDAS, MD

CERTIFICATE OF TRAVEL COMPLETED

Respectfully submitted by:

MARY GRACE O. LEOPARDAS, MD

APPENDIX "A" No.____________________

Grand Total 17,250.00

I CERTIFY THAT: Prepared by:

1. I have reviewed the foregoing itinerary

MARY GRACE O. LEOPARDAS, MD

CERTIFICATE OF TRAVEL COMPLETED

Respectfully submitted by:

MARY GRACE O. LEOPARDAS, MD

1 Cleeford S. Suarez Admin. Aide IV 17,250.00

Republic of the Philippines Fund Cluster :

Mode of MDS Check Commercial Check ADA Others (Please specify)

Address Butuan City

Amount Due 51,750.00

ERNESTO E. PAREJA, MD., MPH

C. Certified: D. Approved for Payment

Printed Name Printed Name

Office DOH CHD CARAGA

To LIQUIDATE the Cash advance of Surigao City

Signature : ___________________________________ Signature ______________________________

Position : Division Chief-LHS Position Administrative Officer V/Budget

Date : ___________________________________ Date ____________________________

You might also like

Signature : _____ Signature

Date : _______ Date