ANNEX A

No. ________________

Republic of the Philippines

Department of Education

AUTHORITY TO TRAVEL FOR OFFICIAL TRAVEL

NAME GLAIDENE V. UMITEN ###

Position/Designation PRINCIPAL V

Permanent Station AGLALANA INTEGRATED SCHOOL

Purpose of Travel PROCESS THE REQUEST FOR APPLICATION FOR FIDELITY BOND OF
(must be supported by
attachments) ACCOUNTABLE PUBLIC OFFICER

Host of Activity DepEd Schools Division of Capiz

Inclusive Dates October 17, 2022

Destination SDO - CAPIZ, Banica, Roxas City

Fund Source MOOE Fund

I hereby attest that the information in this form and in the supporting documents attached hereto are
true and correct.

GLAIDENE V. UMITEN
Name and Signature of Requesting Employee Date

This is to certify that the trip of the requesting employee satisfies all the minimum condictions for authorized
official travel and that alternatives to the travel are insufficient for the purpose stated herei.

MA. LUNIE B. SAMPANI, CPA, MPA

Name and Signature of Recommending Authority Date

Approved:

MIGUEL MAC D. APOSIN EdD, CESO V

Name and Signature of Approving Authority Date

Address: Banica, Roxas City

Contact Number: (036) 620 2371
Email Address: capiz@deped.gov.ph
Website: http://depedcapiz.ph
ANNEX A
 APPENDIX A
No.
Date: October 17, 2022
ITINERARY OF TRAVEL
Name: GLAIDENE V. UMITEN Position: PRINCIPAL V
Official Station: DepEd-Dumarao, AGLALANA INTEGRATED SCHOOL Monthly Salary: ₱
Purpose of Travel: PROCESS THE REQUEST FOR APPLICATION FOR FIDELITY BOND OF ACCOUNTABLE PUBLIC OFFICER

Means of
Date Place to Visit Departure Arrival Transportation Fare Per Diems Total
Oct. 17, 2022 Residence to Camp Jamindan 6:30 am 7:00 am Hired Tricycle 150.00 150.00
Camp Jamindan to PDP Integrated Terminal 7:30 am 9:00 am Jeep 120.00 120.00
PDP Integ. Terminal to Capiz Prov'l. Capitol 9:10 am 9:25 am Jeep 10.00 10.00
Capiz Prov'l. Capitol to SDO-Capiz 9:30 am 9:40 am Tricycle 20.00 20.00
SDO-Capiz to BTr Office (Pueblo de Panay) 10:30 am 11:00 am Tricycle 60.00 60.00
BTr Office (Pueblo de Panay) to Veterans Bank 11:50 am 12:15 pm Tricycle 60.00 180.00 240.00
Veterans Bank to BTr Office (Pueblo de Panay) 2:00 pm 2:25 pm Tricycle 60.00 60.00
BTr Office (Pueblo de Panay) to PDP Integ.Terminal 3:00 pm 3:15 pm Tricycle 20.00 20.00
PDP Integrated Terminal to Camp Jamindan 3:30 pm 5:00 pm Jeep 120.00 120.00
Camp Jamindan to Residence 5:30 pm 6:00 pm Hired Tricycle 150.00 150.00

Total 950.00
(2) (1) I HEREBY CERTIFY THAT I have reviewed the (1) Prepared by:
foregoing itinerary, (2) the travel is necessary to the service,
(3) the period covered is reasonable, (4) the expenses claimed GLAIDENE V. UMITEN
are proper. PRINCIPAL V
(2) Approved by:

MA. LUNIE B. SAMPANI, CPA, MPA MIGUEL MAC D. APOSIN EdD, CESO V
Supervisor/Immediate Supervisor Date
APPENDIX B
DECS, DIVISION OF CAPIZ Date: October 17, 2022
MIGUEL MAC D. APOSIN EdD, CESO V Station: DepEd, Capiz Division
Agency Head

I hereby certify that I have completed the travel authorized in the Itinerary of Travel No.______ dated______________________________
under the conditions indicated below.

_____________ Strictly in accordance with the prepared itinerary:

_____________ Cut short explained below. Excess payment in the amount of_____________________________________
was refunded under O.R. No.________ dated__________________________________________________
_____________ Extended as explained below: Additional itinerary was submitted:
_____________ Other deviations as explained below:
________________________________________________________________________________________________

Attached supporting documents: Certificate of Appearance

___________________________________________________________________________.

On evidence and information of which I have knowledge, the travel was undertaken.
Respectfully submitted:

GLAIDENE V. UMITEN
Name of Employee
MIGUEL MAC D. APOSIN EdD, CESO V PRINCIPAL V
Date Designation
 Department of Education
Region VI - Western Visayas
SCHOOLS DIVISION OF CAPIZ
Banica, Roxas City
ANNEX A
CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS
Pursuant to COA Circular No. 2017-001- dated June 19, 2017
Name of Employee GLAIDENE V. UMITEN Employee No.
Office AGLALANA INTEGRATED SCHOOL

Division SCHOOLS DIVISION OF CAPIZ

Particulars

Oct. 17, 2022 Residence to Camp Jamindan Hired Tricycle 150.00

Camp Jamindan to PDP Integrated Terminal Jeep 120.00
PDP Integ. Terminal to Capiz Prov'l. Capitol Jeep 10.00
Capiz Prov'l. Capitol to SDO-Capiz Tricycle 20.00
SDO-Capiz to BTr Office (Pueblo de Panay) Tricycle 60.00
BTr Office (Pueblo de Panay) to Veterans Bank Tricycle 60.00
Veterans Bank to BTr Office (Pueblo de Panay) Tricycle 60.00
BTr Office (Pueblo de Panay) to PDP Integ.Terminal Tricycle 20.00
PDP Integrated Terminal to Camp Jamindan Jeep 120.00
Camp Jamindan to Residence Hired Tricycle 150.00
0.00
0.00
TOTAL 770.00
Purpose of Travel:

PROCESS THE REQUEST FOR APPLICATION FOR FIDELITY BOND OF

ACCOUNTABLE PUBLIC OFFICER

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

Certified Correct: Noted By:

Signature:
Printed Name:
GLAIDENE V. UMITEN MA. LUNIE B. SAMPANI, CPA, MPA
Employee Immediate Supervisor
Date Date