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    John Rey Ayo
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    This document is a certification form for expenses not requiring receipts from the KALAHI-CIDSS:NCDDP program in Mayorga Leyte. The form includes spaces for the claimant's name, barangay, transportation expenses including date and particulars, total amount, purpose of expenses, and certifications by the claimant and BDC-TWG chair that the expenses were necessary and goods/services were acquired from non-receipt issuing parties. Certifiers acknowledge willful falsification is punishable by law.

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    This document is a certification form for expenses not requiring receipts from the KALAHI-CIDSS:NCDDP program in Mayorga Leyte. The form includes spaces for the claimant's name, barangay, transportation expenses including date and particulars, total amount, purpose of expenses, and certifications by the claimant and BDC-TWG chair that the expenses were necessary and goods/services were acquired from non-receipt issuing parties. Certifiers acknowledge willful falsification is punishable by law.

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    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
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    7 views1 page

    Cenrr

    Uploaded by

    John Rey Ayo
    This document is a certification form for expenses not requiring receipts from the KALAHI-CIDSS:NCDDP program in Mayorga Leyte. The form includes spaces for the claimant's name, barangay, transportation expenses including date and particulars, total amount, purpose of expenses, and certifications by the claimant and BDC-TWG chair that the expenses were necessary and goods/services were acquired from non-receipt issuing parties. Certifiers acknowledge willful falsification is punishable by law.

    Copyright:

    © All Rights Reserved
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    Annex A Annex A

    KALAHI-CIDSS:NCDDP KALAHI-CIDSS:NCDDP
    MAYORGA LEYTE MAYORGA LEYTE
    BARANGAY_____________ BARANGAY_____________
    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 : Name :
    Brgy: Brgy:
    TRANSPORTATION TOTAL AMOUNT TRANSPORTATION TOTAL AMOUNT
    Date Particulars Date Particulars

    TOTAL - TOTAL -
    Purpose: Purpose:

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

    Signature Signature

    Printed Name: Printed Name:


    Claimant BDC-TWG Chair Claimant BDC-TWG Chair

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