Republic of the Philippines

Department of Education
DIVISION OF SULTAN KUDARAT

REQUEST FOR PAYMENT of SALARY (NEWLY HIRED)

Date: ____________________

THE SCHOOLS DIVISION SUPERINTENDENT

DepEd Division of Sultan Kudarat
Kenram, Isulan, Sultan Kudarat

Sir:

PROJECT DEVELOPMENT OFFICER 1

May I request for the payment of my salary as ______________________________________________ of
(Position Title)
________________________,
SANTO BAGUMBAYAN III
NIÑO ELEMENTARY SCHOOL ____________________________, for my services rendered covering the period of
(School) (District)
___________________________.
January 26- February 26,2024 Please credit my net salary to:
(eg. January 1 to 31, 0000)

MARY CLAIRE O. LAGARTO

Bank Account Name: _______________________________
Account Number: __________________________________
005-69278-945-4 (see attached LOI)
May I also request to remit my contributions on premiums and taxes as follows:
GSIS: BP NUMBER: ____________________________
2006418424
HMDF: RTN __________________________________ (see attached application form) PHILHEALTH:
PIN # ___________________________
172527983806 (see attached MDR form)
TAX: TIN #___________________________________
473 615 486 000 (see attached BIR form 1902)

Attached also are my supporting documents (3 copies each) for your perusal:

_____1. Approved Appointment (Certify True Copy) _____4. Oath of Office (Panunumpa)certified true copy
_____2. DTR (Original) _____5. Community Tax Certificate
_____3. Certificate of Assumption to Duty (certified true copy)_____6. SALN (Original)

ADDITIONAL REQUIREMENTS (for transferees only)

_____1. Clearance from Money, Property and Legal Accountabilities
_____2. Certificate of Last Salary received from former agency
_____3. Certificate of Available Leave Credits
_____4. Service Record

Very truly yours, Noted by:

_____________________________
MARY CLAIRE O. LAGARTO __________________________
JOANNE M. SILAYAN
Claimant School Head
------------------------------------------------------------------------------------------------------------------
To be filled up by Accounting Section:

NAME BASIC PERA TOTAL GSIS HDMF PHIC TAX NET PAY

Certified Funds Available: Approved for Payment:

NOLI M. ASUNCION, CPA CRISPIN A. SOLIVEN Jr., CESE

Accountant III Schools Division Superintendent
DSK-OSDS-ACCTG-RPNH-v2r0.0e01.18.21

Serbisyong may Integridad, Kalidad, Angat, at Tapat

Address: Kenram, Isulan, Sultan Kudarat

Telephone No.: (064) 471 1007
Website:https://depedsultankudarat.orgEmail: depedsk.r12@deped.gov.ph