Appendix 32

Republic of the Philippines Fund Cluster :

DEPARTMENT OF EDUCATION
REGION I Date : 03/10/2021
SCHOOLS DIVISION OF ILOCOS SUR DV No. :
STA. CATALINA DISTRICT
ELEM
BP RAGASA ELEMENTARY SCHOOL

DISBURSEMENT VOUCHER 100660-2021-03-0001

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

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee ROMEL T. GALLARDO
4195023
Address Poblacion Sta. Catalina Ilocos Sur

Particulars Responsibility Center MFO/PAP Amount

Reimbursement of Already Paid Expenses 3,782.45

Amount Due 3,782.45

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

ROMEL T. GALLARDO
School Head
B. Accounting Entry:
Account Title UACS Code Debit Credit

Internet Subscription Expeses 5020503000 2,796.00

Electricity Expenses 5020402000 994.70
Due to BIR 2020101000 8.25
Advances For Operating Expenses 1990101000 3,782.45

TOTAL 3,790.70 3,790.70

C. Certified: D. Approved for Payment
X Cash available
X Sup Three Thousand Seven Hundred Eighty Two Pesos &
proper 45/100 Only

Signature Signature

Printed Name MARIE CHIU A. RABINO Printed Name ROMEL T. GALLARDO

Position SENIOR BOOKKEEPER Position HEAD TEACHER II
Date 3/10/2021 Date 3/10/2021
E. Receipt of Payment JEV No.
Date : Bank Name & Account Number:
Check No. : 1221301 3/10/2021
LBP 0402012498
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents

92
 Appendix 32
Republic of the Philippines Fund Cluster :
DEPARTMENT OF EDUCATION
REGION I Date : 03/10/2021
SCHOOLS DIVISION OF ILOCOS SUR DV No. :
STA. CATALINA DISTRICT
ELEM
BP RAGASA ELEMENTARY SCHOOL

DISBURSEMENT VOUCHER 100660-2021-03-0002

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

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee ISECO
555-221-0001
Address Ayusan Norte Vigan City Ilocos Sur

Particulars Responsibility Center MFO/PAP Amount

Payment of Electric Consumption for the month of February

934.44
2021

Amount Due 934.44

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

ROMEL T. GALLARDO
School Head
B. Accounting Entry:
Account Title UACS Code Debit Credit

Electricity Expenses 5020402000 942.45

Due to BIR 2020101000 8.01
Advances For Operating Expenses 1990101000 934.44

TOTAL 942.45 942.45

C. Certified: D. Approved for Payment
X Cash available
X Sup Nine Hundred Thirty Four Pesos & 44/100 Only
proper

Signature Signature

Printed Name MARIE CHIU A. RABINO Printed Name ROMEL T. GALLARDO

Position SENIOR BOOKKEEPER Position HEAD TEACHER II
Date 3/10/2021 Date 3/10/2021
E. Receipt of Payment JEV No.
Date : Bank Name & Account Number:
Check No. : 1221302 3/10/2021
LBP 0402012498
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents

92
 Appendix 32
Republic of the Philippines Fund Cluster :
DEPARTMENT OF EDUCATION
REGION I Date : 03/10/2021
SCHOOLS DIVISION OF ILOCOS SUR DV No. :
STA. CATALINA DISTRICT
ELEM
BP RAGASA ELEMENTARY SCHOOL

DISBURSEMENT VOUCHER 100660-2021-03-0003

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

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee TECHMIX COMPUTER AND GADGETS

Address Vigan City Ilocos Sur

Particulars Responsibility Center MFO/PAP Amount

To recognize payment of office supllies for school:

Gross Amount P 6,060.00
Tax Base P 5,410.71
5,735.35
Witholding Tax
5% 270.54
1% 54.11 324.65
5,735.35
Amount Due 5,735.35
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

ROMEL .T GALLARDO
School Head
B. Accounting Entry:
Account Title UACS Code Debit Credit

Semi Expendable ICT Equipment 5020321003 6,060.00

Due to BIR 2020101000 324.65
Advances For Operating Expenses 1990101000 5,735.35

TOTAL 6,060.00 6,060.00

C. Certified: D. Approved for Payment
X Cash available
X Sup Five Thousand Seven Hundred Thirty Five Pesos & 35/100
proper Only

Signature Signature

Printed Name MARIE CHIU A. RABINO Printed Name ROMEL T. GALLARDO

Position SENIOR BOOKKEEPER Position HEAD TEACHER II
Date 3/10/2021 Date 3/10/2021
E. Receipt of Payment JEV No.
Date : Bank Name & Account Number:
Check No. : 1221303 3/10/2021
LBP 0402012498
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents

92
 Appendix 32
Republic of the Philippines Fund Cluster :
DEPARTMENT OF EDUCATION
REGION I Date : 03/01/2021
SCHOOLS DIVISION OF ILOCOS SUR DV No. :
STA. CATALINA DISTRICT
ELEM
BP RAGASA ELEMENTARY SCHOOL

DISBURSEMENT VOUCHER 100657-2021-03-0004

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

Payment
_________________
COPYLANDIA OFFICE SYSTEMS TIN/Employee No.: ORS/BURS No.:
Payee
CORPORATION 002 332 000 032
Address Zone 6, Bantay, Ilocos Sur

Particulars Responsibility Center MFO/PAP Amount

To recognize payment of office supllies for school:

Gross Amount P 17,190.00
Tax Base P 15,348.21
16,269.11
Witholding Tax
5% 767.41
1% 153.48 920.89
16,269.11
Amount Due 16,269.11
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

RENATO R. RAFANAN
School Head
B. Accounting Entry:
Account Title UACS Code Debit Credit

Office Supplies Expenses 5020301000 17,190.00

Due to BIR 2020101000 920.89
Advances For Operating Expenses 1990101000 16,269.11

TOTAL 17,190.00 17,190.00

C. Certified: D. Approved for Payment
X Cash available
X Sup Sixteen Thousand Two Hundred Sixty Nine Pesos & 11/100
proper Only

Signature Signature

Printed Name MARIE CHIU A. RABINO Printed Name RENATO R. RAFANAN

Position SENIOR BOOKKEEPER Position PRINCIPAL II
Date Date
E. Receipt of Payment JEV No.
Date : Bank Name & Account Number:
Check No. : 1221104 3/1/2020
LBP 0402012471
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents

92
 Appendix 32
Republic of the Philippines Fund Cluster :
DEPARTMENT OF EDUCATION
REGION I Date : 03/01/2021
SCHOOLS DIVISION OF ILOCOS SUR DV No. :
STA. CATALINA DISTRICT
ELEM
BP RAGASA ELEMENTARY SCHOOL

DISBURSEMENT VOUCHER 100657-2021-03-0005

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

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee ZYRA GWEN VARIETY STORE
740 907 520 001
Address Poblacion Sta. Catalina Ilocos Sur

Particulars Responsibility Center MFO/PAP Amount

To recognize payment of office supllies for school:

Gross Amount P 36,549.00
Tax Base P 36,549.00
35,087.04
Witholding Tax
3% 1,096.47
1% 365.49 1,461.96
35,087.04
Amount Due 35,087.04
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

RENATO R. RAFANAN
School Head
B. Accounting Entry:
Account Title UACS Code Debit Credit

Office Supplies Expenses 5020301000 36,549.00

Due to BIR 2020101000 1,461.96
Advances For Operating Expenses 1990101000 35,087.04

TOTAL 36,549.00 36,549.00

C. Certified: D. Approved for Payment
X Cash available
X Sup Thirty Five Thousand Eighty Seven Pesos & 04/100 Only
proper

Signature Signature

Printed Name MARIE CHIU A. RABINO Printed Name RENATO R. RAFANAN

Position SENIOR BOOKKEEPER Position PRINCIPAL II
Date Date
E. Receipt of Payment JEV No.
Date : Bank Name & Account Number:
Check No. : 1221105 3/1/2020
LBP 0402012471
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents

92
 Appendix 32
Republic of the Philippines Fund Cluster :
DEPARTMENT OF EDUCATION
REGION I Date
DV: 7/11/2022
SCHOOLS DIVISION OF ILOCOS SUR No. :
STA. CATALINA DISTRICT
ELEM
CALAWAAN ELEMENTARY SCHOOL

DISBURSEMENT VOUCHER 100660-2022-07-0001

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

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee ZYRA GWEN VARIETY STORE
740-907-520-001
Address Poblacion, Sta. Catalina, Ilocos Sur
Particulars Responsibility Center Amount

To recognize payment of Grocery Items for SBFP 2022

Gross Amount P 700.00
Tax Base P 700.00 686.00
Witholding Tax
1% 7.00
1% 7.00 14.00
686.00
Amount Due 686.00
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

ROMEL T. GALLARDO
School Head
B. Accounting Entry:
Account Title UACS Code Debit Credit

Other Supplies and Materials 5020301000 700.00

Due to BIR 2020101000 14.00
Advances For Operating Expenses 1990101000 686.00

TOTAL 700.00 700.00

C. Certified: D. Approved for Payment
X Cash available
X Sup Six Hundred Eighty-Six Pesos Only
proper

Signature Signature

Printed Name MARIE CHUI A. RABINO Printed Name ROMEL T. GALLARDO

Position SENIOR BOOKKEEPER Position HEAD TEACHER II
Date 7/11/2022 Date 7/11/2022
E. Receipt of Payment JEV No.
Date : Bank Name & Account Number:
Check No. :

Printed Name: Date

Signature :

Official Receipt No. & Date/Other Documents:

 Appendix 60
PURCHASE REQUEST

Entity Name: CALAWAAN ELEMENTARY SCHOOL Fund Cluster: 01101101

Office/Section : PR No.: 2022-05-0009 Date: 05/25/22
_______________________ Responsibility Center Code :

Stock/ Property
Unit Item Description Quantity Unit Cost Total Cost
No.
1 pack Sando Bag 8 ₱ - ₱ -
2 gallon Alcohol 1 ₱ - ₱ -
3 liter Dishwashing Liquid 2 ₱ - ₱ -

TOTAL ₱ -
Purpose: Procurement of Office Supplies
_______________________________________________________________
_______________________________________________________________

Requested by: Approved by:

Signature : _________________________ ___________________________
Printed Name : EDELJALYN R. LIBERATO ROMEL T. GALLARDO
Designation : Property Custodian Head Teacher II
Name of the Procuring Entity Project Reference Number: _____________________________
DepEd, Division Office Name of the Project: Procurement of Office Supplies
Division of Ilocos Sur Location
Location
of the Project:
of Project:
Calawaan
Calawaan
Elementary
Elementary
School
School
Bantay, Ilocos Sur

Standard Form Number: SF – GOOD – 60

Revised on: May 24, 2004
Standard Form Title: Request for Quotation
Date:________________________
Quotation No. ________________

Please quote your lowest price on the item/s listed below, subject to the General Conditions in the last
page, stating the shortest time of delivery and submit your quotation duly signed by your representative not later than
__________________________ @ ____________ p.m in the return envelope attached herewith.

WILBERT R. QUINTUA
BAC Chairman
CALAWAAN ELEMENTARY SCHOOL
Procurement Officer

ITEM NO. Description QTY. UNIT PRIZE TOTAL COST

1 Sando Bag 8
2 Alcohol 1
3 Diswashing Liquid 2

DepEd, Division Office Project Reference Number: .

Division of Ilocos Sur Name of the Project: Procurement of Office Supplies
Bantay, Ilocos Sur Location of the Project: Calawaan Elementary School

After having certainly read and accepted your General Conditions, I/We quote you on the item at prices noted above.

Print Name / Signature

Tel. No./ Cellphone No./ E-mail Address

Date
 DIVISION OF ILOCOS SUR
Bantay, Ilocos Sur
Tel Nos. (077) 722-43-94 & (077)722-36-94

ABSTRACT OF QUOTATION
PROJECT NAME: Procurement of School Supplies
DATE OF BID OPENING: October 28, 2021
VENUE: Calawaan Elementary School

BID SECURITY TOTAL BID IN

NO. NAME OF BIDDER REMARKS
Form Issued By Validity Period Amount PHP
1 Zyra Gwen Variety Store ₱ 7,760.00 LOWEST BIDDER
2 Four JK One General Merchandising ₱ 8,588.40
3 Magic Mart Co. ₱ 9,277.40

WILBERT R. QUINTUA MARILOU P. POBLADOR GEMMALYN R. YADAO

BAC Chairperson BAC Vice - Chairperson BAC Member

SUSANA R. RAPACON Ma. CLARENCE R. PAAT

BAC Member BAC Member

APPROVED:

ROMEL T. GALLARDO
Head Teacher II
 Appendix 61
PURCHASE ORDER

CALAWAAN ELEMENTRAY SCHOOL

Supplier : ZYRA GWEN VARIETY STORE P.O. No. : 2022-0009

Address : Poblacion, Sta. Catalina, Ilocos Sur Date: 05/25/2022
TIN : 740-907-520-001 Mode of Procurement : Shopping
Gentlemen:
Please furnish this Office the following articles subject to the terms and conditions contained herein:

Place of Delivery : Calawaan Elementary School Delivery Term : Delivery

Date of Delivery : 06-15-2021
05/25/2022 Payment Term : Check
Stock/ Property
Unit Description Quantity Unit Cost Amount
No.
1 roll Sando Bag 8 ₱ - ₱ -
2 roll Alcohol 1 ₱ - ₱ -
3 roll Dishwashing Liquid 2 ₱ - ₱ -

(Total Amount in Words) Seven Thousand, Seven Hundred Sixty Pesos Only ₱ -

In case of failure to make the full delivery within the time specified above, a penalty of one-tenth (1/10) of one
percent for every day of delay shall be imposed on the undelivered item/s.

Conforme: Very truly yours,

MARITES L. TORRES ROMEL T. GALLARDO

Signature over Printed Name of Supplier Head Teacher II
05/25/2022 05/25/2022
Date Date

Fund Cluster : ___________________________________ ORS/BURS No. : ____________________

Funds Available : _________________________________ Date of the ORS/BURS: _____________

Amount : ____________________________
LOUIE L. JACOB
Accountant III
 Appendix 62

INSPECTION AND ACCEPTANCE REPORT

Entity Name : Calawaan Elementary School Fund Cluster : 01101101

Supplier : Zyra Gwen Variety Store IAR No. : 2022-07-0001
PO No./Date : 2022-07-0001 /7/11/2022 Date : 7/11/2022
Requisitioning Office/Dept. : _____________________ Invoice No. :
Responsibility Center Code : _____________________ Date : 7/11/2022

Stock/
Description Unit Quantity
Property No.
1 Sando Bag (biodegradable) Medium pack 8
2 Alcohol gallon 1
3 Dishwashing Liquid bottle 2

INSPECTION ACCEPTANCE
Date Inspected : 7/11/2022 Date Accepted : 7/11/2022

Inspected, verified and Complete

found in order as to
quantity and Partial (pls. specify quantity)
specifications

Ma. CLARENCE R. PAAT EDELJALYN R. LIBERATO

Inspection Officer/Inspection Supply and/or Property Custodian
Committee
 Appendix 59

INVENTORY CUSTODIAN SLIP

Entity Name: Calawaan Elementary School

Fund Cluster : ________________________________ ICS No : ______________

Amount
Estimated
Quantity Unit Description Inventory Item No.
Unit Cost Total Cost Useful Life
1 pc ₱ 7,314.00 ₱ 7,314.00 Epson Printer L121 5 years

Received from: Received by:

EDELJALYN R. LIBERATO MA. CLARENCE R. PAAT

Signature Over Printed Name Signature Over Printed Name
School Property Custodian Teacher III
Position/Office Position/Office
9/19/2022 9/19/2022
Date Date
 Republic of the Philippines
For BIR BCS/ Department of Finance
Use Only Item: Bureau of Internal Revenue
BIR Form No.
Certificate of Creditable Tax
2307
January 2018 (ENCS)
Withheld at Source 2307 01/18ENCS
Fill in all applicable spaces. Mark all appropriate boxes with an "X".

1 For the Period From 0 7 0 1 2 0 2 2 (MM/DD/YYYY) To 0 7 3 1 2 0 2 2 (MM/DD/YYYY)

Part I – Payee Information

2 Taxpayer Identification Number (TIN)

7 4 0 - 9 0 7 - 5 2 0 - 0 0 1
3 Payee’s Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)

ZYRA GWEN VARIETY STORE

4 Registered Address 4A ZIP Code

Poblacion, Sta. Catalina, Ilocos Sur 2 7 0 0

5 Foreign Address, if applicable

Part II – Payor Information

6 Taxpayer Identification Number (TIN) 0 0 0 - 5 5 7 - 8 6 0 - 0 0 0

7 Payor’s Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)

DEPED DIVISION OF ILOCOS SUR

8 Registered Address 8A ZIP Code

Bantay, Ilocos Sur 2 7 2 7

Part III – Details of Monthly Income Payments and Taxes Withheld
AMOUNT OF INCOME PAYMENTS
Income Payments Subject to Expanded Tax Withheld for the
ATC 1st Month of the 2nd Month of the 3rd Month of the
Withholding Tax Total Quarter
Quarter Quarter Quarter
Income payments made by the government WI640
to its local/resident suppliers of goods 700.00 700.00 7.00
other than those covered by other rates
of withholding tax

Total 700.00 - - 700.00 7.00

Money Payments Subject to Withholding
of Business Tax (Government & Private)
VAT Withholding on Purchase of Goods WV010 700.00 700.00 7.00

Total 700.00 - - 700.00 7.00

We declare under the penalties of perjury that this certificate has been made in good faith, verified by us, and to the best of our knowledge and belief, is true and
correct, pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof. Further, we give our consent to
the processing of our information as contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

ROMEL T. GALLARDO
Head Teacher II
Signature over Printed Name of Payor/Payor’s Authorized Representative/Tax Agent
(Indicate Title/Designation and TIN)
Tax Agent Accreditation No./ Date of Issue Date of Expiry
Attorney’s Roll No. (if applicable) (MM/DD/YYYY) (MM/DD/YYYY)
CONFORME:

Signature over Printed Name of Payee/Payee’s Authorized Representative/Tax Agent

(Indicate Title/Designation and TIN)
Tax Agent Accreditation No./ Date of Issue Date of Expiry
Attorney’s Roll No. (if applicable) (MM/DD/YYYY) (MM/DD/YYYY)
*NOTE: The BIR Data Privacy is in the BIR website (www.bir.gov.ph)