CBFM Form 04

DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT

KALAHI-CIDSS: NCDDP-AF
Barangay: Borbon
Municipality: San Francisco

PETTY CASH VOUCHER

PAYEE: ANALYN G. FAMILLARAN PCV No. BOR-001

(must be pre-numbered)
Date:

PARTICULARS AMOUNT

TO REIMBURSE THE TRAVEL EXPENSE

TOTAL -

Requested by: Approved by: Received by:

ANALYN G. FAMILLARAN VIRGILIO C. LAGUNA ANALYN G. FAMILLARAN

(Name of Person making the Request) Sub-Project Implementation Head (Print name of person receiving cash)
 KALAHI- CIDSS : NCDDP - AF
Province : Agusan del Sur
Municipality: San Francisco
Barangay :

OFFICE OF THE BARANGAY DEVELOPMENT COUNCIL - TECHNICAL WORKING GROUP

AUTHORITY TO TRAVEL
Date Prepared:

This is to authorize the person (s) stated hereunder to travel for the KC transactions:

Name: ANALYN G. FAMILLARAN

Purpose:
Destination:
Inclusive Date(s):

ITINERARY OF TRAVEL

Name & Signature of the Officer certifying

Means of
Date Place to be Visit Departure Arrival Amount Per Diem Total that the above mentioned name has
Transportation
appeared to this office / establishment.

-
-
-
-
-
-
-
-
-
-
-
-
- - -
Total

Prepared by: Approved by:

ANALYN G. FAMILLARAN VIRGILIO C. LAGUNA

Name of Volunteer PIT CHAIR
 ANNEX A
OFFICE OF THE BARANGAY DEVELOPMENT COUNCIL-TWG
CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS
Pursuant to COA circular No. 2017-001 dated June 19, 2017
Name of Employee Employee No. N/A
Office Barangay Development Council-TWG Barangay
Division/Program DSWD KALAHI-CIDSS NCDDP AF
Date Particulars AMOUNT (P)

TOTAL
I 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 by law. Noted by:
Certified correct:
Signature
Printed Name
BDC-TWG CHAIRPERSON
Date: Date:
Date PCV No. Payee
Prepared by:

Barangay Treasurer
 CBFM FORM/TEMPLATE # 05
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
KALAHI-CIDSS: NCDDP AF

PETTY CASH FUND LIQUIDATION SUMMARY (PCF - )

For the Period of
BARANGAY: BORBON
MUNICIPALITY: SAN FRANCISCO, AGUSAN DEL SUR

Particulars Office Supplies

(inc photo-
copying)
Approved by:
05
DEVELOPMENT

ARY (PCF - )

SAN DEL SUR

Expense Items

Transportation
Meals Others (specify)
Expense
BDC-TWG Chairperson
TOTAL
-
 CBFM TOOL # 4
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
KALAHI-CIDSS: NCDDP AF
BARANGAY: BORBON
MUNICIPALITY: SAN FRANCISCO, AGUSAN DEL SUR

CASH COUNT SHEET

Date of Cash Count:

Beginning Balance:
Less: Expenses
Date PCV No. Particulars Amount

Total Expenses -
Ending Balance -

Cash Count
Denomination No. of Pieces Amount

Total -
Cash Count conducted by: In the presence of:

Audit & Inventory Team Head Brgy. Treasurer

CBFM TOOL # 4
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
KALAHI-CIDSS: NCDDP AF
BARANGAY:
MUNICIPALITY:

CASH COUNT SHEET

Date of Cash Count:

Balance Forwarded: -
Less: Expenses
Date PCV No. Particulars Amount

Total Expenses -
Ending Balance -

Cash Count
Denomination No. of Pieces Amount

Total -

Cash Count conducted by: In the presence of:

Audit & Inventory Team Head Brgy. Treasurer
 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 ________________________________________________

WITNESS
Name/Signature __________________________________________
Address ________________________________________________

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 ________________________________________________

WITNESS
Name/Signature __________________________________________
Address ________________________________________________