Appendix 45

ITINERARY OF TRAVEL
Entity Name :
Fund Cluster: No.: _______________

Name : Date of Travel : JUNE 28-30, 2022

Position : Purpose of Travel : SEMINAR
Official Station :
Places to be visited TIME Means of Transpor- Per Total
Date Others
(Destination) Departure Arrival Transportation station Diem Amount
6/28/2022 Sta. Ana to San Fernando Bus Terminal Jeep 1.00 1.00
San Fernando Bus Terminal to Cubao Bus 190.00 190.00
Cubao to NAIA Terminal 3 Taxi 300.00 300.00
NAIA Terminal 3 to Iloilo Airport (vice versa) Airplane 1.00 1.00
Iloilo Airport to Hotel 1.00 1.00
Hotel to Venue 1.00 1.00
Breakfast to Lunch 360.00 360.00
Accomodation 900.00 900.00
Incidental fee 360.00 360.00
Venue to Hotel 1.00 1.00
2,115.00
6/29/2022
Hotel to Venue 1.00 1.00
Accomodation 900.00 900.00
Incidental fee 360.00 360.00
Venue to Hotel 1.00 1.00
-
1,262.00
6/30/2022
Hotel to Venue 1.00 1.00
Accomodation - -
Incidental fee 360.00 360.00
Venue to Hotel 1.00 1.00
Hotel to Iloilo Airport 1.00 1.00
Dinner 180.00 180.00
NAIA Terminal 3 to Cubao Taxi 300.00 300.00
Cubao to San Fernando Bus Terminal Bus 190.00 190.00
San Fernando Bus Terminal to Station Jeep 1.00 1.00
1,034.00

TOTAL 991.00 540.00 2,880 4,411.00

Prepared by :
I certify that : (1) I have reviewed the foregoing itinerary, (2) the
travel is necessary to the service, (3) the period covered is
reasonable and (4) the expenses claimed are proper.
Approved by:

ARCELI S. LOPEZ, Ph.D. SHIRLEY B. ZIPAGAN, Ph.D. CESE

School Governance & Operations Division, Chief Assistant Schools Division Superintendent
 SEMINAR/TRAINING (REGISTRATION) ELEMENTARY
1 Disbursement Voucher 1 School Head/Payee
2 Photocopy of Check 1
3 Deped Order/ Memoranda, Invitation 1
For School Heads - School Div. Supt.
4 Travel Order 1
5 Itinerary of Travel 1 School Head / SGOD / ASDS
6 Certificate of Travel Completed (Appnendix B) 1 School Head / ASDS
7 Official Reciept (Registration Fee) 1
Original Copy of plane/boat/bus tickets, boarding
8 1
pass, terminal fee receipt
8.1 RER for Taxi/Grab
9 Certificate of Appearance(Original) 1
10 Certificate of Participation (Photocopy) 1
11 Booking Details
Official Reciept ( Air Fare, Accomodation, Terminal
12 Fee)
 Department of Education

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS

Pursuant to COA Circular No. 2017-001 dated June 19, 2017.

Name of Employee Employee No.

Office (Name of School)

Division Division of Pampanga
Particulars Amount(P)
Transpo Expense (Taxi ) going to NAIA for PESPA Seminar at
Iloilo City June 28, 2022 300.00

Total 300.00
Purpose

Attend PESPA Seminar at Iloilo City from June 28 - 30, 2022

I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose, that above goods and services
were acfrom parties not issuing receipts. And that I am fully aware that wilful falsification of statements is punished by law.

Certified correct: Noted by:

Signature

Printed name
Principal ASDS
 CERTIFICATION OF TRAVEL COMPLETED
SCHOOL NAME
Entity Name : Fund Cluster :

Officer in-Charge Station

I HEREBY CERTIFY that I have completed the travel as authorized in the Travel
Order/Itinerary of Travel No. dated under conditions indicated below:

/ x / Strictly in accordance with the approved itinerary.

/ / Cut short as explaoned below. Excess Payment on the amount of
P was refunded under O.R. No. dated
/ / Extended as explained below, additional itinerary was submitted
/ / Other deviation as explained below.
reason why the travel
Explanation or in
is not justifications:
accordance
with the approved
itinerary

documents used, such as

Evidenceplane
of travel : boarding
tickets,
passes, certificate of
appearance, etc.

Respectfully submitted:

na
Name of Employee the
wh
On evidence and information of which I have the knowledge, the travel was actually undertaken.

Approved :

Head of Office
name and signature of
the official/employee
who made the travel
 REPUBLIC OF THE PHILIPPINES Fund Cluster :
DEPARTMENT OF EDUCATION
SCHOOL NAME
High School Blvd., Brgy. Lourdes, City of San Fernando (P)
Date :
DISBURSEMENT VOUCHER DV No. :

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

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee School Head

Address

Responsibility
Particulars MFO/PAP Amount
Center

To record payment of :
Registration Fee
Transportation (Itinerary of Travel)

Amount Due -
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

Name of School Head

Position
B. Accounting Entry:
Account Title UACS Code Debit Credit

C. Certified: D. Approved for Payment

ü Cash available
ü Subject to Authority to Debit Account (when applicable)
ü Supp
proper

Signature Signature

Printed
Printed Name
Name Name of School Head Name of School Head

Position Position
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative

Date Date

E. Receipt of Payment JEV No.

Check/ Date : Bank Name & Account Number:
ADA No. :
Signature : Date : Printed Name: Date

Official Receipt No. & Date/Other Documents