"ANNEX A"

(Actual Transportation Expense)

CERTIFICATION

This is to certify that name of claimant of office incurred transportation expenses for inland
travel in the amount of (Pxxx) at place of travel last date of travel. Name is on official
business travel to (purpose of travel).

Name of claimant is claiming for the excess on transportation expenses for inland travel
incurred as against allowed transportation of P_________/day (20% of DTE) per existing
rate on travelling expenses. Attached are the official receipts for the said amounts.

This is to certify further, that the expenses requested for reimbursement is absolutely
necessary in the performance of his/their duties during (justify the request of
reimbursement).

This certification is being issued to support the claim for reimbursement in the amount of
(Pxxxx- excess of Incidental) representing actual transportation expenses during his/her
travel to place of assignment that may be allowed for payment.

Regional Director
 "ANNEX B"
(Use of Private Vehicle)

CERTIFICATION
This is to certify that the transportation expenses being requested by (name of employee)
for (date of travel) relative to the conduct of the (training) in (venue) from (address of
residence) to (destination) and from (destination) to (residence) in the amount of (total
amount) (back and forth) is for reimbursement of equivalent cost in lieu of hiring public
vehicle.

This further certify that the reimbursement of personal use of vehicle is limited to the round-
trip cost of customary mode of transportation.

Certified by:

___________________________
Name of claimant,
Signature over printed name
Official/Bureau/Unit
Personal Vehicle Plate No.:

Approved by:

EMMA F. PATALINGHUG
SWO IV/Division Chief
Head of Office
 "ANNEX C"
(Actual Hotel Accommodation)

CERTIFICATION
This is to certify that (name of claimant) of (office) incurred hotel accommodation in the
amount of (Pxxxxx) at (name of hotel & address) last (date of travel). (Name) is on official
business travel to (purpose of travel).

(Name of claimant) is claiming for the excess on hotel accommodation/lodging incurred as

against allowed hotel/lodging of P______/day (50% of DTE), which shall not exceed the
100% of the board and lodging component of the DTE. Attached are the official receipt for
the said amounts.

This is to certify further, that the expenses requested for reimbursement is absolutely
necessary in the performance of his/their duties during (justify the request of
reimbursement).

This certification is being issued to support the claim for reimbursement in the amount of
(Pxxxx) representing actual hotel accommodation during his/her travel to (place of
assignment) that may be allowed for payment.

Secretary
 "ANNEX E"

REQUEST FORM TO STAY IN THE PLACE OF

ASSIGNMENT WITHIN 50-KM RADIUS FROM PERMANENT
OFFICIAL STATION

This is to request approval for (name) of (office) residing in (complete address) to stay in
(place of assignment) which is within the 50-km radius from (permanent official station)
(complete address), due to the following justifications:

● _______________________________________

● _______________________________________

● _______________________________________

This is in connection with the travel of (name) on (travel period) for (purpose).

Requested by: Approved by:

_____________________________ ___________________________
(name of employee) (name of official)
Date requested:________________ Date approved:________________
 "ANNEX F"

DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT

JUSTIFICATION FOR THE USE OF

EXTRAORDINARY MEANS OF TRANSPORTATION

Carrying large amount of Cash

Carrying Bulky equipment and important documents
Inclement weather
Accompanying dignitaries or high-level government officials
When time is of essence
Others, (please specify)

Prepared by:

RANDY B. TINGA
Financial Analyst ll

Approved by:

HAZEL DINAH D. MIEL

SWO lV/ Regional Program Coordinator
 “ANNEX H”

Appendix 46

REIMBURSEMENT EXPENSE RECEIPT

Entity Name: Fund Cluster :

_________________ ________________
Date : RER No. :
_______________________ ___________________

RECEIVED from ______________________________________

(Name)

______________________________________________the amount
(Official Designation)

of _______________________________________ (P__________)
(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 ________________________________________________
Reason for non-issuance of tape/official receipt
___________________________________________________

WITNESS
Name/Signature __________________________________________
Address ________________________________________________

“ANNEX D”
(Provision/Non-Provision of Hotel/Lodging, Food and Meals)
 CERTIFICATE OF APPEARANCE

To Whom It May Concern:

This is to certify that Mr./Mrs./Ms.______________________________________ of the
______________________ has personally appeared to _______________________________
on______________________ for the purpose of
__________________________________________________________________.

It is further certified that during the visit/stay of the abovementioned name, this office:
Please
Please affix your check the
signature on appropriat Particulars Inclusive date
appropriate box e box

● Did not provide hotel/lodging, food and

meals
● Provided the following:

⮚ Hotel/ Lodging Accommodation

⮚ Meals
a)
Breakfast
b)
Lunch
c)
Dinner
d)
● Did not provide vehicle

● Provided vehicle

This certification is issued upon request of the interested party for the purpose of establishing the
evidence and duration of his/her appearance hereat, the truth of which is hereby vouchsafed and
guaranteed by the undersigned.

Done in ___________________________________ on ___________________.

(place of issue) (date of issue)

________________________________
(Signature over Printed Name & Position)