OBLIGATION REQUEST AND STATUS

DEPARTMENT OF AGRARIAN REFORM No. : ________________

SARANGANI PROVINCE Date : ________________
Agency Fund : ________________
Payee PABLITO M. OMAMALIN JR
Office DARPO SARANGANI PROVINCE
Address GENERAL SANTOS CITY
Responsibility
Center Particulars MFO/PAP
UACS Code/ Amount
Expenditure

5,150.00

Payment of travelling
expenses

Total 5,150.00
Certified: Charges to appropriation/ allotment necessary, Certified: Allotment available and obligated for the
A. lawful and under my direct supervision; and supporting B. purpose/adjustment necessary as indicated above
documents valid, proper and legal

Signature : Signature :
Printed Name : CENON S. ORIGINAL, CESO VI Printed Name : SHENNA H. GELLANGARIN
Position : OIC-PARPO II Position : Acting Budget Officer II
Head Requesting Office/
Authorized Representative Head, Budget Unit/ Authorized
Representative
Date : ___________________________ Date ___________________________
C: STATUS OF OBLIGATION
Reference Amount Due and
Date Particulars ORS/JEV/RCI/RADAI No. Obligation Payment Not Yet Due Demandab
le
 Fund Cluster:
______________DEPARTMENT OF AGRARIAN REFORM_______________
Entity Name Date:

DV No:
DISBURSEMENT VOUCHER

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

Payee PABLITO M. OMAMALIN JR TIN/Employee No.: ORS/BURS No.:

Address DARPO SARANGANI PROVINCE

Responsibility
Particulars MFO/PAP Amount
Center
Representing Reimbursement of travelling expenses and per diems
incurred while on official travel outside the official station as per 5,150.00
supporting papers hereto attached in the total amount of
……………….

5,150.00
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

ATTY. KAY P. AVILES

ATTY. V/CHIEF LEGAL

B. Accounting Entry:
Account Title UACS Code Debit Credit
C. Certified: D. Approved for Payment
Cash available

Subject to Authority to Debit Account (when applicable)

Supporting document complete and amount claimed

proper
Signature Signature

Printer
Printer Name
Name MARK ANTHONY C. DELA TORRE, CPA CENON S. ORIGINAL, CESO VI
ACCOUNTANT II OIC-PARPO II
Position Position
Head Accounting Unit/Authorized Representative Agency Head/ Authorized Representative

Date Date
JEV No.
E. Receipt of Payment
Date: Bank Name & Account Number :
Check/ ADA
No. :
Date: Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents

 ITINERARY OF TRAVEL

Entity Name : DAR ,

Fund Cluster : No.:

Name : PABLITO M. OMAMALIN JR Date of Travel : MARCH 10-11, 2022

Position : ARPT Purpose of Travel : 1. Participates/conducts OCI on landholding w/ ALI
Official Statio DARPO SANGANI PROVINCE 2. Re: Petition for Qualification/Disqualification

TIME Means of Transpor- Per Total

Date Place to be visited (Destination) tation
Others
Transportation Diem Amount
Departure Arrival

3/10/2022 OS - POB. KIAMBA 7:10 AM 9:05 AM VAN 250.00 1,500.00 1,750.00

KIAMBA - GASI 10:00 AM 11:15 AM MOTORHIRE 390.00 390.00
GASI - SALAKIT 12:30 PM 1:45 PM MOTORHIRE 390.00 390.00
SALAKIT - POB. KIAMBA 3:30 PM 4:45 PM MOTORHIRE 400.00 400.00

3/11/2022 KIAMBA-DATU DANI 8:25 AM 9:45 AM MOTORHIRE 410.00 750.00 1,160.00

DATU DANI-KAYUPO 11:20 AM 12:35 PM MOTORHIRE 400.00 400.00
KAYUPO-POB. KIAMBA 2:30 PM 3:40 PM MOTORHIRE 410.00 410.00
KIAMBA-OS 3:45 PM 5:50 PM VAN 250.00 250.00
 TOTAL 5,150.00
Prepared by :

I certify that : (1) I have reviewed the foregoing itinerary, (2) the PABLITO M. OMAMALIN JR
travel is necessary to the service, (3) the period covered is Signature over Printed Name
reasonable and (4) the expenses claimed are proper.
Approved by :

ATTY. KAY P. AVILES CENON S. ORIGINAL, CESO VI

ATTY. V/CHIEF LEGAL OIC-PARPO II
Signature over Printed Name
Agency Head/Authorized Representative
 Republic of the Philippines
DEPARTMENT OF AGRARIAN REFORM
Tunay na Pagbabago sa Repormang Agraryo

POST-TRAVEL/ ACCOMPLISHMENT REPORT

Name: PABLITO M. OMAMALIN JR

Office: DARPO SARANGANI

Division: LEGAL DIVISION

Date of Travel Place of Travel Purpose of Travel Accomplishment

1. PARTICIPATES/CONDUCTS OCI ON PARTICIPATED/CONDUCTED OCI ON

MARCH 10, 2022
KIAMBA, SARANGANI LANDHOLDING WITH ALI CASE; AND 2. RE: LANDHOLDINGS WITH ALI CASE AND WITH
PROVINCE PETITION FOR PETITION FOR
QUALIFICATION/DISQUALIFICATION QUALIFICATION/DISQUALIFICATION

1. PARTICIPATES/CONDUCTS OCI ON PARTICIPATED/CONDUCTED OCI ON

MARCH 11, 2022
KIAMBA, SARANGANI LANDHOLDING WITH ALI CASE; AND 2. RE: LANDHOLDINGS WITH ALI CASE AND WITH
PROVINCE PETITION FOR PETITION FOR
QUALIFICATION/DISQUALIFICATION QUALIFICATION/DISQUALIFICATION
Prepared by: Noted by:

PABLITO M. OMAMALIN JR ATTY. KAY P. AVILES

ARPT ATTY. V/CHIEF LEGAL

QF-STO-54 Rev 00 Page 1 of 1 Eff. Date: 12/16/2020

 Appendix 47

CERTIFICATE OF TRAVEL COMPLETED

Entity Name: DEPARTMENT OF AGRARIAN REFORM Fund Cluster:

________________

CENON S. ORIGINAL, CESO VI

Agency Head 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.

Explanations of justifications:
__________________________________________________________________________
Evidence of travel:
Approved travel order, Appendix "A", Certificate of Appearance
RER and Post Travel Accomplishment Report
___________________________________________________________________________
___________________________________________________________________________
 Respectfully Submitted:

PABLITO M. OMAMALIN JR.

Name of Employee

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

Approved:

ATTY. KAY P. AVILES

ATTY. V/CHIEF LEGAL
 REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF AGRARIAN REFORM
Tunay na Pagbabago sa Repormang Agraryo

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS

Pursuant to COA Circular No. 2017-001 dated June 19, 2017

Name of Employee Pablito M. Omamalin Jr Employee No. 1204-21-0114

Office DARPO SARANGANI
Division Legal Division
Particulars Amount
Fare from DARPO Sarangani to Poblacion, Kiamba on March 10, 2022 250.00
Fare from Poblacion, Kiamba to DARPO Sarangani on March 11, 2022 250.00

TOTAL 500.00
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 willful falsification of statements is
punishable by law.

Certified correct: Noted by:

Signature

Print Name PABLITO M. OMAMALIN JR ATTY. KAY P. AVILES

Employee Immediate Supervisor
Date: Date: