Cash - Modified Disbursement System (MDS), Regular 1010404000

Advances to Operating Expenses 1990101000

Advances to Special Disbursing Officer 1990104000
Due to BIR 2020101000
Traveling Expenses - Local 5020101000
Training Expenses 5020201000
Office Supplies Expenses 5020301000
Food Supplies Expenses 5020305000
Drugs and Medicines Expenses 5020307000
Medical, Dental and Laboratory Supplies Expenses 5020308000
Textbooks and Instructional Materials Expenses 5020311000
Other Supplies and Materials Expenses 5020399000
Semi-Expendable Machinery and Equipment Expenses 5020321000
Semi-Expendable Furniture, Fixtures and Books Expenses 5020322000
Water Expenses 5020401000
Electricity Expenses 5020402000
Postage and Courier Services 5020501000
Telephone Expenses 5020502000
Internet Subscription Expenses 5020503000
Auditing Services 5021102000
Other Professional Services 5021199000
Janitorial Services 5021202000
Security Services 5021203000
Other General Services 5021299000
Repairs and Maintenance - Buildings and Other Structures 5021304000
Repairs and Maintenance - Machinery and Equipment 5021305000
Repairs and Maintenance - Transportation Equipment 5021306000
Repairs and Maintenance - Furniture and Fixtures 5021307000
Fidelity Bond Premiums 5021502000
Insurance Expenses 5021503000
Printing and Publication Expenses 5029902000
Representation Expenses 5029903000
Transportation and Delivery Expenses 5029904000
Subscription Expenses 5029907000
Other Maintenance and Operating Expenses 5029999000
 DOCUMENTARY REQS CHECKLIST
Name of School: _____________________________________
Name of School Head: ____________________________________
SUPPLIES & MATERIALS EXPENSE (Office, School & IT supplies, Ink) ELECTRIC & WATER EXPENSES
Supplies /Materials 1 Official Receipt
1 Disbursement Voucher 2 Statement of Account / Billing Statement
2 Sales Invoice (specifying quantity, description & unit cost) 3 Tax Payment & BIR Form 2306 & 2307
3 Official Receipt
4 Tax Payment & BIR Form 2306 & 2307 TELEPHONE &/or INTERNET EXPENSES
5 Purchase Request 1 Official Receipt
6 Request for Quotation (3) 2 Statement of Account / Billing Statement
7 Abstract of Quotation 3 Tax Payment & BIR Form 2306 & 2307
8 Purchase Order
9 Inspection & Acceptance Report PRINTING & PUBLICATION EXPENSES
10 Inventory Custodian Slip
11 Certification from the head of agency as to the necessity I. Photocopies & Binding (tarpaulin, school ID,)
& jurisdiction of the purchase; and that the price paid or contracted 1 Sales Invoice (specifying quantity, description & unit cost)
for is reasonable and that it was the lowest obtainable at the time of 2 Official Receipt
purchase order 3 Tax Payment & BIR Form 2306 & 2307
12 Pictures with signature of Principal 4 Job Request
5 Request for Quotation (3)
OTHER SUPPLIES & MATERIALS EXPENSES 6 Abstract of Quotation
(Sports Materials; Janitorial, Industrial, Agri supplies, etc.) 7 Job Order
1 All reqs are the same with SUPPLIES & MATERIALS EXPENSES 8 Inspection & Acceptance Report
2 Certification (indicating description & purpose) 9 Certification (indicating Purpose, Description, Unit Cost,
3 Inventory Custodian Slip # of copies & that no collection was made from students)
4 Pictures with signature of Principal 10 Pictures with signature of Principal (Tarpaulin)

II. Testpapers
REPAIRS & MAINTENANCE EXPENSES OF GOV'T FACILITIES 1 Sales Invoice (specifying quantity, description & unit cost)
(Only Minor Expenses allowed: < P50,000) 2 Official Receipt
Materials 3 Tax Payment & BIR Form 2306 & 2307
1 Disbursement Voucher 4 Job Request
2 Sales Invoice (specifying quantity, description & unit cost) 5 Request for Quotation (3)
3 Official Receipt 6 Abstract of Quotation
4 Tax Payment & BIR Form 2306 & 2307 7 Job Order
5 Pre-Inspection Report 8 Inspection & Acceptance Report
6 Program of Work 9 Certification of No Collection from students with breakdown of:
7 Purchase Request # of students, # of copies, unit cost & total amount
8 Request for Quotation (3)
9 Abstract of Quotation SECURITY & UTILITY EXPENSES
10 Purchase Order 1 Payroll
11 Inspection Report 2 Approved Job Order
12 Final Inspection & Acceptance Report 3 DTR
13 Pictures (before, during & after repairs) 4 Accomplishment Report
14 ORs of continuing project 5 Job Description
15 Inventory List of School Properties (for repairs of equipments & facilities)
FIDELITY BOND EXPENSE
1 Validated Deposit Slip / ONCOLL Payment Slip
IV. Labor ( Not more than 35% of Materials) 2 ATAP (Authority to Accept Payment)
1 Disbursement Voucher 3 List of Bonded Officials (w/ Risk No.)
2 Payroll
3 Tax Payment & BIR Form 2306 & 2307 TRAVELING EXPENSES
4 Request for Quotation (3) 1 Approved Itinerary of Travel
5 Abstract of Quotation 2 Travel Order / Authority to Travel
3 Certificate of Appearance
TRAINING EXPENSES 4 Certificate of Travel Completed
1 Disbursement Voucher
2 Official Receipt (for training/seminar registration fee) GAD EXPENSES
3 Memo &/or DepEd Order for Seminars & Trainings attended 1 Approved GAD Plan/Proposal
4 Travel Order / Authority to Travel 2 Attendance
5 Certificate of Appearance 3 Accomplishment Report
4 Pictures with signature of Principal
Note: Liquidation of supplies and materials used is subject to
usual liquidation
BIR WITHHOLDING TAX

Sale of Goods
Vat- Register
Gross Amount / 1.12 multiply by 5% and 1%
Example
Gross Amount Amount of Payment 2306 (5%) 2307 (1%) Net of Tax (OR)
8,500.00 7,589.29 379.46 75.89 8,044.64

Non- Vat
Gross Amount Amount of Payment 2306 (3%) 2307 (1%) Net of Tax (OR)
8,500.00 8,500.00 255.00 85.00 8,160.00

Services

Vat- Register
Gross Amount / 1.12 multiply by 5% and 2%
Example
Gross Amount Amount of Payment 2306 (5%) 2307 (2%) Net of Tax (OR)
8,500.00 7,589.29 379.46 151.79 7,968.75

Non- Vat
Gross Amount Amount of Payment 2306 (3%) 2307 (2%) Net of Tax (OR)
8,500.00 8,500.00 255.00 170.00 8,075.00
 LIQUIDATION REPORT Serial No.: _________________
Period Covered __________________ Date: _____________________

Entity Name : SAN FRANCISCO ELEMENTARY SCHOOL Responsibility Center Code:

Fund Cluster : _01 - REGULAR FUND __________________________
Period Covered __________________
PARTICULARS AMOUNT

To Liquidate MOOE Cash Advance of San Francisco Elementary School, Victoria

West District for the month of NOVEMBER 2017 as per attached supporting
papers in the amount of . . . . . . .

TOTAL AMOUNT SPENT

AMOUNT OF CASH ADVANCE PER DV NO.______DTD. ______ -
AMOUNT REFUNDED PER OR NO. ________DTD. ___________ -
AMOUNT TO BE REIMBURSED -
A Certified: Correctness of the Certified: Purpose of travel / Certified: Supporting documents
above data cash advance duly accomplished complete and proper

ELENA P. BARTOLO DR. NOEL L. LINSAO DIVINA GRACE P. RAIZ

Principal I OIC - Assistant Schools Division
Claimant Superintendent
Immediate Supervisor
Date: ______________________ Date: _____________________
Administrative Assistant III
Accounting Division Unit
JEV No.: ___________________
Date: _____________________
____________
 CASH DISBURSEMENTS
For the month of ______________

Entity Name: SAN FRANCISCO ELEMENTARY SCHOOL

Sub-Office/District/Division: VICTORIA WEST DISTRICT
Municipality/City/Province: SCHOOLS DIVISION OF TARLAC PROVINCE
Fund Cluster : 01 - REGULAR

Advances for
Operating Expenses
(19901010)
DV/Payroll/
Date Particulars Amount
Check No.

Cash
Advance

2,000.00

2,000.00
Totals
CERTIFIED CORRECT:

ELENA P. BARTOLO
Principal I
Signature over Printed Name

Date: ____________________
 Appendix 43

H DISBURSEMENTS REGISTER
onth of ____________________________

Name of Accountable Officer: ELENA P. BARTOLO

Official Designation: Principal I
Station: _______________________________________
Register No. : __________________________________
Sheet No. : ____________________________________

Advances for
Operating Expenses BREAKDOWN OF PAYMENTS
(19901010)
Amount OTHERS
Traveling Electricity Office Supplies
Payments Expenses Expenses Expenses
Account UACS Object
Balance
Description Code
(50201010) (50204020) (50203010)
2,000.00

100.00 100.00
1,900.00
-
1,900.00
-
1,900.00
-
1,900.00
-
1,900.00
-
1,900.00
100.00 1,900.00 100.00 - -

Recapitulation:

UACS Object
Account Description
Code
 Total

The total of the ‘Advances for Operating Expenses – Payments’ column must always be equal to the sum of the totals of the
‘Breakdown of Payments’ columns.
RECEIVED BY:

DIVINA GRACE P. RAIZ

Administrative Assistant III
Signature over Printed Name

Date: ______________________
 Appendix 43

ENA P. BARTOLO

____________
____________
____________

ERS

Amount

Amount
 -

to the sum of the totals of the

 Republic of the Philippines
Department of Education
Region III – Central Luzon
SCHOOLS DIVISION OF TARLAC PROVINCE

SCHOOL: SAN FRANCISCO ELEMENTARY SCHOOL

SUMMARY OF EXPENSES
FOR THE MONTH OF NOVEMBER 2017

2307 EXPANDED 2306 FINAL

DV NO. NAME OF PAYEE GROSS AMOUNT WITHOLDING TAX NET AMOUNT
(2% OR 1%) (5% OR 2%)
2017-09-001 TARELCO II 3,160.81 56.44 141.11 2,963.26
2017-09-002 KENI TANA ENTERPRISES 980.00 8.75 43.75 927.50
2017-09-003 RAMONCITO DAET 4,000.00 - - 4,000.00
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

TOTAL 8,140.81 65.19 184.86 7,890.76

PREPARED BY: CERTIFIED CORRECT BY:

School Treasurer PRINCIPAL I

CONFORMED:

BAC Chairman
BAC Co Chairman

Member
 Department of Education
Region III – Central Luzon
SCHOOLS DIVISION OF TARLAC PROVINCE
VICTORIA WEST DISTRICT
SAN FRANCISCO ELEMENTARY SCHOOL
Victoria, Tarlac

DATE

PRE- INSPECTION REPORT

Name / Location of School / Project : SAN FRANCISCO ELEMENTARY SCHOOL

always indicate the project
Victoria, Tarlac specification and the date
prepared
Repair of Grade I Classroom's Ceiling.

This is to certify that based on inspection conducted on __June 26, 2016___________ at

Dapdap Resettlement Elementary School - San Nicolas, Victoria, Tarlac__ the following were noted, to wit:

Purpose:

CONCURRED:

Proprerty Custodian INSPECTED BY:

Chairman Inspectorate Team

APPROVED:

ELENA P. BARTOLO
Principal I
 Republic of the Philippines
Department of Education
Region III – Central Luzon
SCHOOLS DIVISION OF TARLAC PROVINCE
VICTORIA WEST DISTRICT
SAN FRANCISCO ELEMENTARY SCHOOL
Victoria, Tarlac

PROGRAM OF WORK
PROJECT: Repair of Grade I Classroom's Ceiling.
Address: Victoria, Tarlac

BILL OF MATERIALS

Item
No. Quantity Unit Commodity and Description Unit Cost Total Amount

1 1 pc 2x1x10 good lumber 40.00 40.00

2 1 pack Hollowblocks 23.00 23.00
3 2 kl nail 1" 1.00 2.00
4 3 pc plywood 2.00 6.00
5 1 pc 2x2x10 13.00 13.00
6 -
7 -
8 -
9 -
10

Estimated Cost of materials………………………………………………………….. 84.00

Estimated Cost of Labor . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . .
Total Estimated Cost of Materials and Labor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84.00

Prepared by:
Bids and Awards Committee:

Industrial Arts Teacher/Member

Faculty President / Chairman

Member
ELENA P. BARTOLO
 Principal I
Member
 Republic of the Philippines
Department of Education
Region III – Central Luzon
SCHOOLS DIVISION OF TARLAC PROVINCE
VICTORIA WEST DISTRICT
SAN FRANCISCO ELEMENTARY SCHOOL
Victoria, Tarlac

PURCHASE REQUEST

Entity Name: SAN FRANCISCO ELEMENTARY SCHOOL Fund Cluster: 01 - REGULAR

Office/Section : _____________ PR No.: ______________dapat pong fill upan: Date: ____________
year-month-serial
____________________ Responsibility Center Code : ___________
number
Stock/ Property
Unit Item Description Quantity Unit Cost Total Cost
No.

pc 2x1x10 good lumber 1 40.00 40.00

pack Hollowblocks 1 23.00 23.00
kl nail 1" 2 1.00 2.00
pc plywood 3 2.00 6.00
pc 2x2x10 1 13.00 13.00
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -

Purpose: ____________________________________________________________
_______________________________________________________________
_______________________________________________________________
pur
Requested by: Approved by: nee
port
Signature :
Printed Name : ELENA P. BARTOLO
Designation : Industrial Arts Teacher Principal I

depende po kung sino

ang nagrequest
 PANIQUI CHRISTIAN SCHOOL INC.
Carriedo Street Poblacion Sur Paniqui, Tarlac
Tel.no: (045)931-0091
Email: paniquichristianschool@yahoo.com

PURCHASE ORDER

Supplier : ___ MEGASAVER P.O. No. : ___ 2022-06-00001

Address : ____ PANIQUI TARLAC Date : _______ 6/29/2022
TIN : ________________________________________________ Mode of Procurement : BUYING MATERIALS
Gentlemen:
Please furnish this Office the following articles subject to the terms and conditions contained herein:

Place of Delivery : _________ PCSI Delivery Term : ________________________ dapat po itong fi

Date of Delivery : ____________________________________ Payment Term : ________________________ year-month-ser
number
Stock/
Unit Description Quantity Unit Cost Amount
Property No.
1 PCS HANABISISHI WALL FAN 16" (MODEL: WI 3 1,435.00 4,305.00
2 PCS CAMEL ORBIT FAN 16" (MODEL:COF-16) 18 1,940.00 34,920.00
pack Hollowblocks 1 23.00 23.00
kl nail 1" 2 1.00 2.00
pc plywood 3 2.00 6.00
pc 2x2x10 1 13.00 13.00
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 -
0 0 0 -

(Total Amount in Words)

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,

__________________________ ELENA P. BARTOLO

Signature over Printed Name of Supplier Signature over Printed Name of Authorized Official
___________________________ Principal I
Date Designation

Fund Cluster : ___________________________________ ORS/BURS No. : ______________________

Funds Available : _________________________________ Date of the ORS/BURS: _______________
________________________________________ Amount : ____________________________
Signature over Printed Name of Chief Accountant/Head of
Accounting Division/Unit
 Contract Reference Number:
Name of Contract:
Location of the Contract:

ABSTRACT OF QUOTATION
Sheet: ____________________
Contract Name: SAN FRANCISCO ELEMENTARY SCHOOL Date: _____________________
Contract Location: Victoria, Tarlac Time: ____________________

Implementing Office: SAN FRANCISCO ELEMENTARY SCHOOL

Approved Budget for the Contract:

Supplier 1/Laborer 1 Supplier 2/Laborer 2 Supplier 3/Laborer 3

DOCUMENTS SUBMITTED

a.) Duly signed RFQ, prices shall be quoted

in the Philippine Peso;
b.) Mayor's Permit issued by the city or
municipal mayor where the principal
place of business is located;
c.) D.T.I. Business Registration for single
Proprietorship or SEC Registration for
Corporation
d.) G-EPS Registration certificate
e.) B.I.R. Tax Clearance
f.) Latest ITR duly received by the BIR
REMARKS: in case the same po ung
amount ng bid ng 2 or 3
suppliers, indicate po dito
Amount of Quotation: ung advantage ng
napiling supplier

Awarded to: Approved:

winning bidder without ELENA P. BARTOLO

signature Principal I
 Republic of the Philippines
Department of Education
Region III - Central Luzon
DIVISION OF TARLAC PROVINCE
San Roque, Tarlac City

REQUEST FOR QUOTATION

Date: ____________________

To all Prospective Suppliers:

Please quote your lowest price inclusive of VAT on the item/s listed below, subject to the Terms and
Conditions of this RFQ, and submit your quotation duly signed by your representative in sealed envelope
to the Division Supply Office, Macabulos Drive, San Roque, Tarlac City.

School Administrative

Item. Unit Total

Unit Item & Description Quantity
No. Price Amount
Chopping board
1 Straw
2 Swizzle sticks
3 Cocktail umbrella
4 Bottle opener
5 Breadbasket
6 Fruit stand
7 Tea / coffee strainers
8 Chaffing dish
9 Tooth picks
10 Paper napkins
11 Doilley
12 All purpose knife
13 Butter knife
14 Cheese knife
15 Fish knife
16
17
18
19

This is to submit our price quotationas indicated above subject to the terms and conditions of this RFQ.
Supplier's Company Name:
Address:
Tel. No.: TIN No.:
Signature: Date:
 Republic of the Philippines
Department of Education
Region III – Central Luzon
SCHOOLS DIVISION OF TARLAC PROVINCE
VICTORIA WEST DISTRICT
SAN FRANCISCO ELEMENTARY SCHOOL
Victoria, Tarlac

INSPECTION REPORT

OFFICE : DEPED - SAN FRANCISCO ELEMENTARY SCHOOL

DEALER : 0
ADDRESS :

Item
No. Quantity Unit Commodity and Description Unit Cost Total Amount

1 1 pc 2x1x10 good lumber 40.00 -

2 1 pack Hollowblocks 23.00 -
3 2 kl nail 1" 1.00 -
4 3 pc plywood 2.00 -
5 1 pc 2x2x10 13.00 -
6 0 0 0 - -
7 0 0 0 - -
8 0 0 0 - -
9 0 0 0 - -

Estimated Cost of Materials -

Purchased Ref. No. _____________ Purchased No. ____________ Date: ________________

Delivered at SAN FRANCISCO ELEMENTARY SCHOOL
Invoice No. ______________ Date: ______________ Inspection on ___________________

FINDINGS RECOMMENDATIONS:

Certified correct as to the quantity and specifications acceptance.

Certified & Verified Correct:

Inspectorate Team:

0
Chairman
Noted:
0
Member ELENA P. BARTOLO
Principal I
0
Member
in this line always indicate the details of sales invoce
 Republic of the Philippines
Department of Education
Region III – Central Luzon
SCHOOLS DIVISION OF TARLAC PROVINCE
VICTORIA WEST DISTRICT
SAN FRANCISCO ELEMENTARY SCHOOL
Victoria, Tarlac

REPORT OF FINAL INSPECTION AND ACCEPTANCE

PROJECT: Repair of Grade I Classroom's Ceiling.

LOCATION: SAN FRANCISCO ELEMENTARY SCHOOL

This is to inform you that upon final inspection conducted on _______________________

of the above mentioned project/s by the School Repair and Maintenance Committee (SRMC) it was found
out that the project was satisfactorily completed in accordance with the plans and specification stipulated in
the Program of Work.

With this, the school is now fully recognizes the completion of the project and hereby accepted
the responsibility over this project and shall take appropriate measures to maintain its good condition.

BIDS AND AWARDS COMMITTEE:

0
Faculty President / Chairman

0
Member Approved:

0 ELENA P. BARTOLO
Member Principal I
ccepted
 Republic of the Philippines
Department of Education
Region III – Central Luzon
SCHOOLS DIVISION OF TARLAC PROVINCE
VICTORIA WEST DISTRICT
Victoria, Tarlac

INSPECTION AND ACCEPTANCE REPORT

Entity Name: SAN FRANCISCO ELEMENTARY SCHOOL Fund Cluster : 01 - REGULAR

Supplier : IAR No. : _______________ dapat pong fill up

Year-month-seria
PO No./Date : Date : __________________ number
Requisitioning Office/Dept. : ______________________________ Invoice No. : ___________
Responsibility Center Code : _______________________________ Date : __________________

Stock/
Description Unit Quantity
Property No.
1

INSPECTION ACCEPTANCE
Date Inspected : _________________________ Date Received : ______________________

Inspected, verified and found in order as to Complete

quantity and specifications
Partial (pls. specify quantity)

Inspection Officer/Inspection Committee Supply and/or Property Custodian

 Appendix 46

REIMBURSEMENT EXPENSE RECEIPT

Entity Name : ___________________________ Fund Cluster : _01 - REGULAR________

Date : ______________________________ RER No. : ___________________

RECEIVED from _______________________________________________

(Name)
_______________________________________ the amount of
(Official Designation)
_________________________________________ (PhP.__________________)
(In Words) (in Figures)
in payment for __________________________________________________________________._
(Payments for subsistence, services,
___________________________________________________________________________
rental or transportation should show inclusive dates,

___________________________________________________________________________
purpose, distance, inclusive points of travel, etc.)

PAYEE
Name/Signature ___________________________________________________
Address __________________________________________________ lagi pong i
no.
Res. Cert. No.: _________________________ Date of Issue: ________________________
Place of Issue: ________________________________
WITNESS
Name/Signature _________________________________________________________
Address ________________________________________________ lagi pong
Res. Cert. No.: _________________________ Date of Issue: ________________________ no.

Place of Issue: ________________________________

 PAYRO
For the period ___

Entity Name : SAN FRANCISCO ELEMENTARY SCHOOL

Fund Cluster : 01 - REGULAR
We acknowledge receipt of cash shown opposite our name as full compensation for services rendered for the period covered.

COMPENSATIONS
Serial Employee
Name Position Salaries and
No. No.
Wages-Regular

A CERTIFIED: Services duly rendered as stated.

School Administrative Officer

Signature over Printed Name of Authorized Official Date

B CERTIFIED: Supporting documents complete and proper; and cash available in the amount
of P______________________.

Administrative Assistant III

(Signature over Printed Name) Date
Head of Accounting Division/Unit
 PAYROLL
For the period _______________

dapat pong
Payroll No.: year-month
Sheet _________of __________Sheets number
endered for the period covered.

COMPENSATIONS DEDUCTIONS
Net Amount
Gross Amount Total Due
Earned Deductions

C APPROVED FOR PAYMENT: _________________________________________________________________

_____________________________________________________________________(P

School Head
(Signature over Printed Name) Date
Head of Agency/Authorized Representative

D CERTIFIED: Each employee whose name appears on the payroll has E

been paid the amount as indicated opposite his/her name

School Treasurer
(Signature over Printed Name)
Disbursing Officer
 Appendix 33
dapat pong fill upan:
year-month-serial
f __________Sheets number
Signature of Recipient
_______________________________
_______________(P
ORS/BURS No. : _______________
Date : ____________________
JEV No. : _____________________
Date : ____________________
PAYRO
INSTRUCT
A. The Payroll is a form used by an agency/entity
monetary benefits to its officers/employees for a s
B. This form shall be accomplished as follows:
1. For the period – period covered by the payro
2. Entity Name – name of the agency/entity
3. Fund Cluster – the fund cluster name/cod
obligation should be charged
) 4. Payroll No. – payroll number assigned by the
5. Sheet ____ of ____ Sheets – sheet number
6. Serial No. – entry number in the payroll
7. Name – complete name of the officers/emplo
8. Position – position of officers/employees in t
9. Employee No. – employee number assigned
10. Compensations – compensations being rece
Wages-Regular, PERA, etc. Additional colum
necessary.
11. Gross Amount Earned – total amount of sal
period
12. Deductions – amount of authorized deduc
 necessary.
11. Gross Amount Earned – total amount of sal
period
12. Deductions – amount of authorized deduc
premium, GSIS contributions/loans, etc. fr
Additional columns shall be provided by the a
13. Total Deductions – total amount of deductio
14. Net Amount Due – gross amount earned less
15. Signature of Recipient – signature of of
representative receiving the net amount
16. Box A – certification by the authorized officia
17. Box B – certification of the Head of Accoun
propriety of the supporting documents and
certification was signed
18. Box C – approval by the Head of the Agency
payment covered by the Payroll, and the date
19. Box D – certification of the Authorized Off
employee whose name appears on the payr
opposite his/her name, and the date the certifi
20. Box E – the assigned ORS/BURS and JEV nu

C. This form shall be prepared in four (4) copies to b

Original – Accounting Division/Unit toge

documents for submission to th
Copy 2 – Cash/Treasury Unit
Copy 3 – Payroll Section, Accounting Di
Copy 4 – Payroll Head
 documents for submission to th
Copy 2 – Cash/Treasury Unit
Copy 3 – Payroll Section, Accounting Di
Copy 4 – Payroll Head
 PAYROLL

INSTRUCTIONS

ed by an agency/entity to pay salaries, wages, PERA, and other

icers/employees for a specific period of time or on a given date.

lished as follows:

od covered by the payroll

of the agency/entity
fund cluster name/code in accordance with UACS in which the
harged
number assigned by the Accounting Division/Unit
heets – sheet number
mber in the payroll
e of the officers/employees covered by the payroll
officers/employees in the payroll
oyee number assigned by the agency/entity concerned
mpensations being received by the employee such as Salaries and
A, etc. Additional columns shall be provided by the agency/entity as

d – total amount of salaries and other compensations earned for the

t of authorized deductions such as withholding tax, Philhealth

d – total amount of salaries and other compensations earned for the

t of authorized deductions such as withholding tax, Philhealth

ibutions/loans, etc. from the employee’s gross amount earned.
all be provided by the agency/entity as necessary.
tal amount of deductions
oss amount earned less total deductions
nt – signature of officer/employee, or his/her duly authorized
ceiving the net amount due
y the authorized official that services was duly rendered as stated.
of the Head of Accounting Division/Unit on the completeness and
orting documents and the availability of cash, and the date the
d
he Head of the Agency or his/her Authorized Representative on the
e Payroll, and the date the certification was signed
of the Authorized Official/Employee/Disbursing Officer that each
e appears on the payroll has been paid the amount as indicated
and the date the certification was signed
ORS/BURS and JEV numbers and their respective dates

d in four (4) copies to be distributed as follows:

ing Division/Unit together with the supporting

nts for submission to the COA Auditor for post audit
easury Unit
Section, Accounting Division/Unit
Head
nts for submission to the COA Auditor for post audit
easury Unit
Section, Accounting Division/Unit
Head
 Republic of the Philippines
Department of Education
Region III - Central Luzon
Schools Division of Tarlac Province
VICTORIA WEST DISTRICT
SAN FRANCISCO ELEMENTARY SCHOOL
Victoria, Tarlac

Date

CERTIFICATION
To Whom It May Concern:

This is to certify that the supplies/materials purchased are very necessary for the purpose in which they
are intended for use.

This certifies further that the materials were used purposely for ___________________________.

It is certified that the price paid or contracted for is reasonable and that it was at the lowest obtainable
at the time of purchase order.

_________________________
School Treasurer

_________________________
Faculty President Approved:

_________________________ ELENA P. BARTOLO

Primary Teachers' Representative Principal I
 Republic of the Philippines
Department of Education
Region III - Central Luzon
Schools Division of Tarlac Province
VICTORIA WEST DISTRICT
SAN FRANCISCO ELEMENTARY SCHOOL
Victoria, Tarlac

Date

CERTIFICATION
To Whom It May Concern:

This is to certify that the supplies/materials purchased are very necessary for the purpose in which they
are intended for use.

This certifies further that the materials were used purposely for ___________________________.

Grade No. of Student No. of copies Unit cost Total Amount

It is certified that the price paid or contracted for is reasonable and that it was at the lowest obtainable
at the time of purchase order. Furthermore, there's no collection have been made to students.

_________________________
School Treasurer

_________________________
Faculty President Approved:

_________________________ ELENA P. BARTOLO

Primary Teachers' Representative Principal I
 Appendix 45

ITINERARY OF TRAVEL

Entity Name : DepEd - Schools Division of Tarlac Province

Fund Cluster: REGULAR FUND No.: _______________

Name : ELENA P. BARTOLO Date of Travel :

Position : Principal I Purpose of Travel : _OFFICIAL BUSINESS_____
Official Station : SAN FRANCISCO ELEMENTARY SCHOOL ___________________________________________

Places to be visited TIME Means of Transpor- Per

Date Others
(Destination) Departure Arrival Transportation station Diem Total Amount

6/9/2017 San Francisco ES to Division Office 11:05 AM 12:05 NN various 60.00 80.00 140.00
Division Office to San Francisco ES 4:00 PM 5:00 PM 60.00 60.00
06/15/2017 San Francisco ES to Division Office 11:05 AM 12:05 NN various 60.00 80.00 140.00
Division Office to San Francisco ES 4:00 PM 5:00 PM 60.00 60.00
-
-
-
-
-
-
-
-
-
-
-
-
-

TOTAL 240.00 160.00 - 400.00

Prepared by :

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

DR. NOEL L. LINSAO

OIC - Assistant Schools Division Superintendent
Agency Head/Authorized Representative
kung sa travel po ng
teachers kelangan pong
may pirma sa portion na
ito ang School Head.
kung sa travel po ng
teachers kelangan pong
may pirma sa portion na
ito ang School Head.
 Republic of the Philippines
Department of Education
Region III - Central Luzon
SCHOOLS DIVISION OF TARLAC PROVINCE
Macabulos Drive, San Roque, Tarlac City

08/31/17
Date
DR. ESTRELITA S. CUNANAN
OIC- Schools Division Superintendent
DepEd-Division of Tarlac Province
San Roque, Tarlac City

Madam:

This is to request Authority to Travel listed below:

DepEd – Division Office, Division of Tarlac Province

on 08/31/17 ,to

The objective/s of the visit is/are:

1. to submit cash advance voucher on MOOE and other pertinent papers

2. to submit checked and completed liquidation reports
3.

DIVINA GRACE P. RAIZ

Administrative Assistant III
Name of Requesting School Official

Action Taken:

( ) Approved
( ) Disapproved

Approved:

DR. NOEL L. LINSAO

OIC - Assistant Schools Division Superintendent

Certificate of Apperance No: ________________

 Appendix 47

CERTIFICATION OF TRAVEL COMPLETED

Entity Name: SAN FRANCISCO ELEMENTARY SCHOOL Fund Cluster: 01 - REGULAR

DR. ESTRELITA S. CUNANAN DepEd - Schools Division of Tarlac Province

OIC -Schools Division Superintendent 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 explained below. Excess payment in the amount of
P_______ was refunded under O. R. No. ________ dated __________
/ / Extended as explained below, additional itinerary was submitted
/ / Other deviation as explained below.

Explanation or justifications:
__________________________________________________________

Evidence of travel:
__________________________________________________________
__________________________________________________________

Respectfully submitted:

ELENA P. BARTOLO
Principal I

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

Approved:

DR. NOEL L. LINSAO

OIC - Assistant Schools Division Superintendent
 INVENTORY CUSTODIAN SLIP
Appendix 59
Entity Name: SAN FRANCISCO ELEMENTARY SCHOOL
dapat p
Fund Cluster : _ 01 - REGULAR ICS No.: _______________ year-m
numbe
Amount Inventory Estimated
Quantity Unit Description
Unit Cost Total Cost Item No. Useful Life

Received from: Received By:

Signature over Printed Name Signature over Printed Name

SCHOOL PROPERTY CUSTODIAN

Position / Office Position / Office
Date Date
 BIR Form No.
Certificate of Final Tax
2306
Republika ng Pilipinas
Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas
Withheld At Source September 2005 (ENCS)
1 For the Period
From 03 01 16 (MM/DD/YY)
05 To 03 31 16 (MM/DD/YY)
05
Part I Income Recipient/Payee Information Withholding Agent/Payor Information
2 TIN 3 TIN
106
102 057
214 588
389 000 000 863 958 243
4 Payee's Name (For Non-Individuals ) 5 Payor's Name (For Non- Individuals)
NEW KENT
MORALES
LUMBER
GLASS
& HARDWARE
SUPPLY DEPED SCHOOLS DIVISION OF TARLAC PROVINCE
6 Payee's Name (Last Name, First Name, Middle Name) For Individuals 7 Payor's Name (Last Name, First Name, Middle Name) For Individuals

8 Registered Address 9 Registered Address

San Nicolas,
Zamora St., Cut-Cut
Tarlac City
1, Tarlac City Macabulos Drive, San Roque, Tarlac City
8A Zip 9A Zip
Code 2300 Code 2300
10 Foreign Address 10A Zip Code 10B ICR No. (For Alien Income Recipient Only)

Part II Details of Income Payment and Tax Withheld (Attach additional sheet if necessary)
Nature of Income Payment ATC Amount of Payment Tax Withheld ang
VAT WITHHOLDING ON PURCHASE OF GOODS WV010 9,137.50 456.88
ung
alisi
divi

Total 9,137.50 456.88

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.
BRENDEE P. MARTIN Accountant III
Payor/Payor's Authorized Representative/Accredited Tax Agent TIN of Signatory Title/Position of Signatory Date Signed
Signature Over Printed Name

Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Date of Issuance Date of Expiry
CONFORME:
NEW KENT LUMBER & HARDWARE
Payee/Payee's Authorized Representative/Accredited Tax Agent TIN of Signatory Title/Position of Signatory Date Signed
Signature Over Printed Name

Tax Agent Accreditation No./Attorney's Roll No. (if applicable)
To be accomplished for Value-Added Tax/Percentage Tax Withholding (substituted filing)
I declare, under the penalties of perjury, that the information
herein stated are reported under BIR Form No. 1600 which
have been filed with the Bureau of Internal Revenue.
Payor/Payor's Authorized Representative/Accredited Tax Agent
Signature Over Printed Name
Date of Issuance Date of Expiry
I declare under the penalties of perjury that I am qualified under substituted filing of Percentage
Tax/Value Added Tax Returns (BIR Form 2551M/2550M/Q), since I have only one payor from
whom I earn my income; that, in accordance with RR 14-2003, I have availed of the Optional
Registration under the 3% Final Percentage Tax Wthholding/10% Final VAT Withholding in lieu
of the 3% Percentage Tax/10% VAT in order to be entitled to the privileges accorded by the
Substituted Percentage Tax Return/Substituted VAT Return System prescribed in the aforesaid
Regulations; that, this Declaration is sufficient authority of the withholding agent to withhold 3%
Final Percentage Tax/10% Final VAT from my sale of goods and/or services.

TIN of Signatory Title/Position of Signatory Payee/Payee's Authorized Representative/Accredited Tax Agent Title/Position of Signatory
Signature Over Printed Name

Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Tax Agent Accreditation No./Attorney's Roll No. (if applicable) TIN of Signatory

Date of Issuance Date of Expiry Date of Issuance Date of Expiry

Date of Issuance Date of Expiry Date of Issuance Date of Expiry

ang papalitan lang po
ung amount wag pong
alisin sa formula ang
divided by 1.12
 BIR Form No.

Certificate of Creditable Tax

2307
Republika ng Pilipinas
Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas
Withheld At Source September 2005 (ENCS)

1 For the Period

03
05 01 16 03
05 1011
31 16
From (MM/DD/YY) To (MM/DD/YY)
Part I Payee Information
2 Taxpayer
Identification Number
106
102 057
214 588
389 000
3 Payee's Name NEW
NEW MORALES GLASS&SUPPLY
KENT LUMBER HARDWARE
(Last Name, First Name, Middle Name for Individuals) (Registered Name for Non-Individuals)
4 Registered Address San Nicolas,
Zamora St., Cut-Cut
Tarlac City
1, Tarlac City 4A Zip Code
2313
2300
5 Foreign Address 5A Zip Code

Payor Information
6 Taxpayer
Identification Number 000 863 958 243
7 Payor's Name
DEPED- SCHOOLS DIVISION OF TARLAC PROVINCE
(Last Name, First Name, Middle Name for Individuals) (Registered Name for Non-Individuals)
8 Registered Address 8A Zip Code
Macabulos Drive , San Roque, Tarlac City 2300
PART II Details of Monthly Income Payments and Tax Withheld for the Quarter
Income Payments Subject to AMOUNT OF INCOME PAYMENTS
ATC
Expanded Withholding Tax 1st Month of 2nd Month of 3rd Month of Total Tax Withheld
the Quarter the Quarter the Quarter For the Quarter
Income payments made by the WI 640 9,137.50 9,137.50 91.38 ang pa
government to its local/resident ung am
alisin s
suppliers of goods divide

Total 9,137.50 91.38

Money Payments Subject to Withholding
of Business Tax (Government & Private)

Total - -
We declare, under the penalties of perjury, that this certificate has been made in good faith, verified by me, and to the best of my 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.
BRENDEE P. MARTIN Accountant III
Payor/Payor's Authorized Representative/Accredited Tax Agent TIN of Signatory Title/Position of Signatory
(Signature Over Printed Name)

Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Date of Issuance Date of Expiry
Conforme:
NEW KENT LUMBER & HARDWARE
Payee/Payee's Authorized Representative/Accredited Tax Agent TIN of Signatory Title/Position of Signatory Date Signed
(Signature Over Printed Name)

Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Date of Issuance Date of Expiry
ang papalitan lang po
ung amount wag pong
alisin sa formula ang
divided by 1.12
 BIR Form No.
Certificate of Final Tax
2306
Republika ng Pilipinas
Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas
Withheld At Source September 2005 (ENCS)
1 For the Period
From 04 01 16
(MM/DD/YY) To 04 30 16 (MM/DD/YY)
Part I Income Recipient/Payee Information Withholding Agent/Payor Information
2 TIN 3 TIN
239 796 412 000 000 863 958 243
4 Payee's Name (For Non-Individuals ) 5 Payor's Name (For Non- Individuals)
RCE PAINT CENTER DEPED SCHOOLS DIVISION OF TARLAC PROVINCE
6 Payee's Name (Last Name, First Name, Middle Name) For Individuals 7 Payor's Name (Last Name, First Name, Middle Name) For Individuals

8 Registered Address 9 Registered Address

Faigal St., Sto. Cristo, Guimba, Nueva Ecija Macabulos Drive, San Roque, Tarlac City
8A Zip 9A Zip
Code 2313 Code 2300
10 Foreign Address 10A Zip Code 10B ICR No. (For Alien Income Recipient Only)

Part II Details of Income Payment and Tax Withheld (Attach additional sheet if necessary)
Nature of Income Payment ATC Amount of Payment Tax Withheld
Money payment subject to WB 080 7,470.00 224.10
withholding of business tax
by government

Total 7,470.00 224.10

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.
BRENDEE P. MARTIN Accountant III
Payor/Payor's Authorized Representative/Accredited Tax Agent TIN of Signatory Title/Position of Signatory Date Signed
Signature Over Printed Name

Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Date of Issuance Date of Expiry
CONFORME:
RCE PAINT CENTER
Payee/Payee's Authorized Representative/Accredited Tax Agent TIN of Signatory Title/Position of Signatory Date Signed
Signature Over Printed Name

Tax Agent Accreditation No./Attorney's Roll No. (if applicable)
To be accomplished for Value-Added Tax/Percentage Tax Withholding (substituted filing)
I declare, under the penalties of perjury, that the information
herein stated are reported under BIR Form No. 1600 which
have been filed with the Bureau of Internal Revenue.
Payor/Payor's Authorized Representative/Accredited Tax Agent
Signature Over Printed Name
Date of Issuance Date of Expiry
I declare under the penalties of perjury that I am qualified under substituted filing of Percentage
Tax/Value Added Tax Returns (BIR Form 2551M/2550M/Q), since I have only one payor from
whom I earn my income; that, in accordance with RR 14-2003, I have availed of the Optional
Registration under the 3% Final Percentage Tax Wthholding/10% Final VAT Withholding in lieu
of the 3% Percentage Tax/10% VAT in order to be entitled to the privileges accorded by the
Substituted Percentage Tax Return/Substituted VAT Return System prescribed in the aforesaid
Regulations; that, this Declaration is sufficient authority of the withholding agent to withhold 3%
Final Percentage Tax/10% Final VAT from my sale of goods and/or services.

TIN of Signatory Title/Position of Signatory Payee/Payee's Authorized Representative/Accredited Tax Agent Title/Position of Signatory
Signature Over Printed Name

Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Tax Agent Accreditation No./Attorney's Roll No. (if applicable) TIN of Signatory

Date of Issuance Date of Expiry Date of Issuance Date of Expiry

 BIR Form No.

Certificate of Creditable Tax

2307
Republika ng Pilipinas
Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas
Withheld At Source September 2005 (ENCS)

1 For the Period

04 01 16 04 1011
30 16
From (MM/DD/YY) To (MM/DD/YY)
Part I Payee Information
2 Taxpayer
Identification Number 239 796 412 000
3 Payee's Name RCE PAINT CENTER
(Last Name, First Name, Middle Name for Individuals) (Registered Name for Non-Individuals)
4 Registered Address 4A Zip Code
Faigal St., Sto. Cristo, Guimba, Nueva Ecija
5 Foreign Address 5A Zip Code

Payor Information
6 Taxpayer
Identification Number 000 863 958 243
7 Payor's Name
DEPED- SCHOOLS DIVISION OF TARLAC PROVINCE
(Last Name, First Name, Middle Name for Individuals) (Registered Name for Non-Individuals)
8 Registered Address 8A Zip Code
Macabulos Drive , San Roque, Tarlac City 2300
PART II Details of Monthly Income Payments and Tax Withheld for the Quarter
Income Payments Subject to AMOUNT OF INCOME PAYMENTS
ATC
Expanded Withholding Tax 1st Month of 2nd Month of 3rd Month of Total Tax Withheld
the Quarter the Quarter the Quarter For the Quarter
Income payments made by the WI 640 7,470.00 7,470.00 74.70
government to its local/resident
suppliers of goods

Total 7,470.00 74.70

Money Payments Subject to Withholding
of Business Tax (Government & Private)

Total - -
We declare, under the penalties of perjury, that this certificate has been made in good faith, verified by me, and to the best of my 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.
BRENDEE P. MARTIN Accountant III
Payor/Payor's Authorized Representative/Accredited Tax Agent TIN of Signatory Title/Position of Signatory
(Signature Over Printed Name)

Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Date of Issuance Date of Expiry
Conforme:
RCE PAINT CENTER

Payee/Payee's Authorized Representative/Accredited Tax Agent TIN of Signatory Title/Position of Signatory Date Signed
(Signature Over Printed Name)

Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Date of Issuance Date of Expiry