Republic of the Philippines

Department of Education
Date:

Signature here
FOR: NAME OF SCHOOL HEAD
Position/Designation

AS TO THE
ALLOTMENT OF Signature here
OBLIGATION: NAME OF BOOKKEPEER
Position / Designation

Signature here
FROM: NAME OF PROPONENT/S
Position/Designation

SUBJECT: Activity Request

NAME OF
PROGRAM(S)/ Program/Project Name: Enhancement of School Improvement Plan
PROJECT(S)
OUTPUT(S) TO BE State the “Output Code(s)” and the corresponding final output(s) to be
PRODUCED AND produced as reflected in the WFP including the physical target.
ITS CODE(S)
Output Code Output Physical Target
1. Enhanced School Improvement Plan
n/a 1
(Sample only)

ACTIVITY/IES TO Specific activities to be undertaken in order to produce the output. It may be a

BE REQUESTED series of workshops, trainings, writeshops, conferences, research initiatives,
studies, etc.

Activity Code Name of Activity/ies

001 1. Data Gathering Activities (Sample only)
002 2. Meeting with the School Planning Team (Sample only)
003 3. Workshop on the Enhancement of SIP (Sample only)
004 4. Printing of the Enhanced SIP (Sample only)

ACTIVITY/IES Write NONE if there is no request for

WITH downloading of funds.
DOWNLOADING Otherwise, indicate Specific OUs who NONE
will receive the downloaded funds,
 exact amount to be downloaded, and
its purpose.
ACTIVITY/IES TO Identify activity/ies to be bumped-off, if any, to cover expenses required to
BE BUMPED-OFF certain activity/ies in case that the requested amount exceeds with the approved
AND ITS CODE(S) budget in WFP.
Activity Code Name of Activity Amount to be bumped-off
n/a n/a n/a

Grand Total P _________________

FINANCIAL Amount being requested (must reflect the amount indicated in WFP).
REQUIREMENTS Attach the detailed computation for pre-audit, per activity, showing the grand
total.
Requirement for this transaction as follows:
Activity Code Amount in WFP Amount Requested
001 2,000.00 2,000.00
002 1,000.00 1,000.00
003 5,000.00 5,000.00
004 1,000.00 1,000.00

Grand Total 9,000.00 9,000.00

SOURCE OF Indicate Line Item per GAA and Funding Year
FUNDS Example: School MOOE
ADMINISTRATIVE Articulation of administrative arrangements (participants, inclusive dates,
ARRANGEMENTS special disbursing officer of the activity, and the other relevant information per
activity including cost-sharing arrangements, if necessary)
Activity Sub-Activities Pax Inclusive Remarks
Code Dates
1. Data Gathering
001 10 Jan. 20, 2022
Activities (Sample only)
2. Meeting with the
002 School Planning Team 10 Jan. 25, 2022
(Sample only)
3. Workshop on the
003 Enhancement of SIP 30 Feb. 1, 2022
(Sample only)
4. Printing of the
004 Enhanced SIP (Sample n/a Feb. 15, 2022
only)
ANNEXES 1. Activity Design/Program of Activities
2. List of Participants
3. Detailed Budget Estimates
4. Certification from Clearing House, if needed in the activity
5. Accomplished Purchase Request (PR), if any
6. Legal instrument or any form of directives from person in authority
7. Portion of the approved WFP where activities are stipulated

All expenses incurred in this activity is subject to usual accounting and auditing rules and regulations.