Itenerary of Travel

REPUBLIC OF THE PHILIPPINES

PHILPPINE STATISTICS AUTHORITY

Name: JIM ROSS P. CANIBAN Date of Travel:March 1-15, 2023

Position: REGISTRATION KIT OPERATOR Purpose of Travel:
Official Station: PSO BUKIDNON
Residence:PUROK 17 CASISANG MALAYBALAY BUKIDNON PhilSys Step 2 and Step 3 (Mode 1 and Mode 2) Registration

PLACES TO BE VISITED TIME Means of Transportat

EO 77 Total Amount
Transportation ion
DATE (Destination) Departure Arrival

(1) (3) (4) (5) (6) (8) (9)

March 01, 2023 Brngy Colambogon to La Roxas Purok 1,2,3,4,5,7,8,9 6:40 AM 7:51 AM Motorcycle 290.00 290.00
March 02, 2023 Brngy Dagumbaan to Purok 1,2,3,4,5,6,7,8,9 7:16 AM 7:56 AM Motorcycle 290.00 290.00
March 03, 2023 Brngy Anahawon Purok 1,2,3,4,5,6,7 and Brngy Bayabasaon Purok 1,2,3,4,5,6,7,8 7:00 AM 7:30 AM Motorcycle 295.00 295.00
March 04, 2023 Brngy South Purok 7,8,9,11,1,2 7:11 AM 7:40 AM Motorcycle 285.00 285.00
March 05, 2023 Brngy South Purok 3,4,5,6,11,9,2,1,8, 7:00 AM 7:51 AM Motorcycle 290.00 290.00
March 06, 2023 DAY OFF 7:25 AM 7:48 AM - -
March 07, 2023 ABSENT - -
March 08, 2023 ABSENT - -
March 09, 2023 ABSENT - -
March 10, 2023 Brngy San Roque Purok 1,2,3,4,5,6,7,8,9 7:15 AM 7:48 AM 290.00 290.00
March 11, 2023 - -
March 12, 2023 - -
March 13, 2023 - -
March 14, 2023 - -
March 15, 2023 - -
March 16, 2023 - -
March 17, 2023 - -
March 18, 2023 - -
March 19, 2023 - -
March 20, 2023 - -
March 21, 2023 - -
March 22, 2023 - -
March 23, 2023 - -
March 24, 2023 - -
March 25, 2023 - -
March 26, 2023 - -
March 27, 2023 - -
March 28, 2023 - -
March 29, 2023 - -
March 30, 2023 - -
March 31, 2023 - -

TOTAL..... 1,740.00 - 1,740.00

I certify that: (1) I have reviewed the foregoing Prepared by:

itinirary, (2) the travel is necessary to the service,
(3) the period covered is reasonable and (4) the JIM ROSS P. CANIBAN
expenses claimed are proper

Approved by:

MARIA EVANGELINE N. NON MARIA EVANGELINE N. NON

(CHIEF STATISTICAL SPECIALIST) (CHIEF STATISTICAL SPECIALIST)
Officer - in - Charge Officer - in - Charge
 Appendix 11

OBLIGATION REQUEST AND STATUS Serial No. : _01-101101-2022 - 12 -___

PHILIPPINE STATISTICS AUTHORITY Date :
Provincial Statistics Office - Bukidnon Fund Cluster : 01
Payee JIM ROSS P. CANIBAN
Office
MARAMAG BUKIDNON
Address
PUROK 17 CASISANG MALAYBALAY BUKIDNON

Responsibility Center Particulars MFO/PAP UACS Object Code Amount

1,740.00

Total 1,740.00
A. Certified: Charges to appropriation/alloment are B. Certified: Allotment available and obligated
necessary, lawful and under my direct supervision;and for the purpose/adjustment necessary as
supporting documents valid, proper and legal indicated above

Signature : Signature :
Printed Name: Printed Name:
MARIA EVANGELINE N. NON ELLAMAE T. AQUINO
Position : (CHIEF STATISTICAL SPECIALIST) Position : Accountant I

Head, Requesting Office/Authorized Representative

Head, Budget Division/Unit/Authorized Representative

C. STATUS OF OBLIGATION
Reference Amount
Balance
ORS/JEV/Check/ Obligation Payable Payment Due and
Date Particulars Not Yet Due
ADA/TRA No. Demandable
(a) (b) (c) (a-b) (b-c)
Traveling Expenses - 1,740.00 1,740.00 1,740.00 - -
- -
- -
- -
- -
- -
TOTAL 1,740.00 1,740.00 1,740.00 - -

original copy - COA

copy 2 - cashier
copy 3 - accounting
copy 4 - budget
 Appendix 32
PHILIPPINE STATISTICS AUTHORITY Fund Cluster :
Provincial Statistics Office - Bukidnon 01
Date :

DISBURSEMENT VOUCHER DV No. :

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

Payment
_________________

Payee JIM ROSS P. CANIBAN TIN/Employee No.: ORS/BURS No.:

PUROK 17 CASISANG MALAYBALAY BUKIDNON

Address

Responsibility
Particulars MFO/PAP Amount
Center

Payment for Reimbursement expenses incurred

PhilSys Step 2 and Step 3 (Mode 1 and Mode 2) Registration
AMOUNT OF . . . . . . . . . 1,740.00

Amount Due 1,740.00

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

MARIA EVANGELINE N. NON

(SSS)Officer in Charge
Printed Name, Designation and Signature of Supervisor

B. Accounting Entry:
Account Title UACS Code Debit Credit
Traveling Expenses - Local 5 02 01 010 1,740.00

Cash - MDS 1010404000 1,740.00

C.Certified: D. Approved for Payment
Cash available
Subject to Authority to Debit Account (when applicable)
Supp
proper

Signature Signature

Printed
Printed Name
Name ELLAMAE T. AQUINO MARIA EVANGELINE N. NON
Accountant I (CHIEF STATISTICAL SPECIALIST)
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative

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

original copy - COA

copy 2 - cashier
copy 3 - Accounting
Reference No. 19-FAS-03-180

REPUBLIC OF THE PHILIPPINES

PHILPPINE STATISTICS AUTHORITY
ANNEX "D"

Payee/Claimant to submit the accomplished form with the applicable

supporting documents

CHECKLIST FOR REIMBURSEMENT OF TRAVELLING EXPENSES

FOR LOCAL TRAVEL

Not
Documentary Requirements Submitted Remarks
Submitted
(please check)
1 Disbursement Voucher (in 2 copies)
(signature of Focal Person or CSS)
2 Obligation Request and status
3 Duly Approved Itinerary of Travel (4 copies)
Paper/Electronic plane, boat or bus tickets,
4 boarding pass, terminal fee, Taxi Receipt, toll
fee.

5 Certificate of Attendance/Appearance
Special Order/Travel Order signed by the
6 NS/RD/CSS or Authorized Signatory
Revised or supplemental Special Order signed by
the National Statistician or Authorized Signatory
7 supporting the change of schedule (if applicable)

Certificate of Expenses not Requiring Receipts

8 (for expenses not exceeding Php300.00) (2
copies)
9 Certificate of Travel Completed
Other:
10 Specify____________________
____________________

I hereby certify on the necessity and legality of charges to allotments as well as the validity, propriety and legality
of supporting documents

JIM ROSS P. CANIBAN

REGISTRATION KIT OPERATOR
(Printed name, Designation, Signature of Payee/Claimant)

Date Submitted:
Date :
 REPUBLIC OF THE PHILIPPINES REPUBLIC OF THE PHILIPPINES
PHILPPINE STATISTICS AUTHORITY PHILPPINE STATISTICS AUTHORITY
Province of Bukidnon Province of Bukidnon
City of Malaybalay City of Malaybalay
ANNEX A ANNEX A
CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS
Pursuant to COA Circular No. 2017-001- dated June 19, 2017 Pursuant to COA Circular No. 2017-001- dated June 19, 2017
Name of Employee JIM ROSS P. CANIBAN Employee No. PRO-RKO-022 Name of Employee JIM ROSS P. CANIBAN Employee No. PRO-RKO-022
Office CIVIL REGISTRATION Office CIVIL REGISTRATION
Division BUKIDNON Division BUKIDNON
Particulars Amount((₱) Particulars Amount ((₱)
Motorcycle Brngy Colambogon to La Roxas Purok 1,2,3,4,5,7,8,9 290.00 Motorcycle Brngy Colambogon to La Roxas Purok 1,2,3,4,5,7,8,9 290.00
Motorcycle Brngy Dagumbaan to Purok 1,2,3,4,5,6,7,8,9 290.00 Motorcycle Brngy Dagumbaan to Purok 1,2,3,4,5,6,7,8,9 290.00
Motorcycle Brngy Anahawon Purok 1,2,3,4,5,6,7 and Brngy Bayabasaon Purok 1,2,3,4,5,6,7,8 295.00 Motorcycle Brngy Anahawon Purok 1,2,3,4,5,6,7 and Brngy Bayabasaon Purok 1,2,3,4,5,6,7,8 295.00
Motorcycle Brngy South Purok 7,8,9,11,1,2 285.00 Motorcycle Brngy South Purok 7,8,9,11,1,2 285.00
Motorcycle Brngy South Purok 3,4,5,6,11,9,2,1,8, 290.00 Motorcycle Brngy South Purok 3,4,5,6,11,9,2,1,8, 290.00
0 DAY OFF - 0 DAY OFF -
0 ABSENT - 0 ABSENT -
0 ABSENT - 0 ABSENT -
0 ABSENT - 0 ABSENT -
0 Brngy San Roque Purok 1,2,3,4,5,6,7,8,9 290.00 0 Brngy San Roque Purok 1,2,3,4,5,6,7,8,9 290.00
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 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 - 0 0 -
0 0 - 0 0 -
0 0 - 0 0 -
0 0 - 0 0 -

0 0 - 0 0 -

TOTAL 1,740.00 TOTAL 1,740.00

Purpose Purpose
PhilSys Step 2 and Step 3 (Mode 1 and Mode 2) Registration PhilSys Step 2 and Step 3 (Mode 1 and Mode 2) Registration

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

Signature: Signature:
Printed Name: JIM ROSS P. CANIBAN MARIA EVANGELINE N NON Printed Name: JIM ROSS P. CANIBAN MARIA EVANGELINE N NON
REGISTRATION KIT OPERATOR (CHIEF STATISTICAL SPECIALIST) REGISTRATION KIT OPERATOR (CHIEF STATISTICAL SPECIALIST)
Employee Immediate Supervisor Employee Immediate Supervisor
Date Date Date Date
 Appendix 47

CERTIFICATION OF TRAVEL COMPLETED

Entity Name: Philippine Statistics Authority - Bukidnon Fund Cluster: ___

MARIA EVANGELINE N. NON Malaybalay City

(Supervising Statistical Specialist) Station
Officer-in-Charge

I HEREBY CERTIFY THAT I have completed the travel as authorized in the Special Order/
Travel Order No. dated: March 1 - 15, 2023 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:

JIM ROSS P. CANIBAN

REGISTRATION KIT OPERATOR

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

Approved:

MARIA EVANGELINE N. NON

(CHIEF STATISTICAL SPECIALIST)