LOAD

INPUTS ON BASIC INFORMATIONS (e-liquidation-tolitz2022-revised) - FOR GOODS/SERVICES
A. H E A D I N G - BASIC INFORMATIONS G. TAXES WITHHELD

DECIMAL
1 DEPARTMENT: Deprartment of Education 7 SCHOOL HEAD:(ALLCAPS) ALFIE M. ANGEL 59 BIR FORMS TAX RATE % FORM
2 REGION: Region III 8 DESIGNATION (sCAPS): School Principal I 60 2306 1600 MONTHLY 1 0.01
3 DIVISION: NUEVA ECIJA 9 LIQUIDATION FOR THE MONTH OF: JANUARY 61 2307 0619-E MONTHLY 1 0.01
4 DISTRICT: (sCAPS) SDO Cuyapo West Annex 10 YEAR: (yyyy) 2022 62 REN-REN VARIETY STORE
TIN NO. OF SCHOOL HEAD: (abc-def-ghi-jkl) 275-596-995-000
VAT or
5 SCHOOL: (ALL CAPS) D.R JOSE ELEMANTARY SCHOOL 11 TIN NO. OF SCHOOL: (abc-def-ghi-jkl) 493-663-892-385 63 2307 0619-EQ QUARTERLY 1 NON-VAT
GOODS or
6 SCHOOL ADDRESS: (sCAPS) Sabit, Cuyapo, Nueva Ecija 12 SCHOOL ADDRESS: (ALL CAPS) Latap, Cuyapo, Nueva Ecija 64 2307 1604-E ANNUAL 1 SERVICES
B. DISBURSEMENT VOUCHER (DV) 65 ABSTRACT OF CANVASS BID: VAT SERVICES
PAYEE/SUPPLIER BUSENESS
13 FUND CLUSTER: 06 21
NAME: (ALL CAPS) REN-REN VARIETY STORE
66 WITH CANVASS 999 1.12
14 DATE: (mm-dd-yyyy): 01/30/2023 22 ADDRESS: (ALL CAPS) NAMPICUAN, NUEVA ECIJA WITH CANVASS TRUE
TIN NO./EMPLOYEE NO.OF
15 DV NO.(yyyy-mm): 2023-01-001 23
PAYEE/SUPPLIER: (abc-def-ghi-jkl) 424-094-00001
Payment for the purchase of load
16 OR/Invoice No.: 2051 24 PARTICULARS: (sCAPS)
card
67 SUMMARY
17 GROSS AMOUNT (from INPUT-PO): 1,500.00 25 SCHOOL TREASURER (ALL CAPS): GROSS (1) 1,500.00 1 or 1.12 1
MARIZA R. ALFONSO 68
18 CHECK NO.: 26 SCHOOL INSPECTION (ALL CAPS): SINAMAR D. CONCEPCION 69

2306 2307
TOTAL CHECK 1,470.00
19 PO NO.-PR NO.-IAR NO.: 2023-01-001 27 SCHOOL PROPERTY (ALL CAPS): ROSE S. LANUZA 70 15.00 15.00
20 BANK AND ACCT. NO. (ALL CAPS): LANDBANK OF THE PHILIPPINES 28 NAME OF SUPPLIER (ALL CAPS): MARINELA V. UCOL
C. INSPECTION AND ACCEPTANCE (ADDITIONAL INFORMATIONS) H. OTHER INFO: (BIR FORMS 2306 - 2307)
29 DATE INSPECTED (mm-dd-yyyy): 01-30-2023 30 DATE RECEIVED (mm-dd-yyyy): 01/30/2023 71 FROM: 01-01-2023
AMOUNT OF TAXES FOR THE PERIOD
D. PURCHASE ORDER (ADDITIONAL INFORMATIONS) 72 TO: 01-31-2023
ZIP CODE ZIP CODE
31 DATE OF DELIVERY (mm-dd-yyyy): 01/30/2023 34 DELIVERY TERM (ALL CAPS): COD 73 (PAYEE/SUPPLIER): 3117 (PAYOR/SCHOOL):
32 MODE OF PROCUREMENT (ALL CAPS): GOODS 35 PAYMENT TERM (ALL CAPS): CHECK
AMOUNT IN WORDS
33 FUNDS AVAILABLE: MOOE 36
(CHECK AMT.) (lowercase): e.MAIL ADDRESS OF SCHOOL HEAD: (lowercase)
one thousand four hundred seventy
E. PURCHASE REQUEST (ADDITIONAL INFORMATIONS)
alfie.angel01@deped.gov.ph
37 PURPOSE (sCAPS): For school load supplies AMOUNT IN WORDS

(GROSS AMT.) (lowercase):
one thousand five hundred
F. REQUEST FOR QUOTATIONS - (ALL CAPS)

WITH CANVASS REN-REN VARIETY STORE
38
QUOTATION-SUPPLIER 01 41 NAME OF SUPPLIER: FERDINAND F. SANGALANG
REN-REN VARIETY STORE 42 DESIGNATION: PROPRIETOR
43 COMPANY/BUSENESS NAME: REN-REN VARIETY STORE
44 BUSENESS ADDRESS: NAMPICUAN NUEVA ECIJA

45 CP NUMBER: N/A
46 e-MAIL ADDRESS: N/A
39
QUOTATION-SUPPLIER 02 47 NAME OF SUPPLIER: AUGUSTO LADON
LADON'S COPY CENTER & GEN. MDSE 48 DESIGNATION: PROPRIETOR
49 COMPANY/BUSENESS NAME:
LADON'S COPY CENTER & GEN.
MDSE
50 BUSENESS ADDRESS: CUYAPO, NUEVA ECIJA
51 CP NUMBER: N/A

40
QUOTATION-SUPPLIER 03 53 NAME OF SUPPLIER: ARNEL DE GRACIA
PHOTOPIX PRINTING 54 DESIGNATION: PROPRIETOR
55 COMPANY/BUSENESS NAME: PHOTOPIX PRINTING
56 BUSENESS ADDRESS: CUYAPO, NUEVA ECIJA
57 CP NUMBER: N/A

VICES
ATC
WB080
WI640
1,500.00
NON-VAT
GOODS
AT SERVICES
1,339.29
1500.00
TOTAL TAX
WITHHELD
30.00
023
023
3117
wercase)
Page 1 of 12
Deprartment of Education
Region III
NUEVA ECIJA
SDO Cuyapo West Annex
D.R JOSE ELEMANTARY SCHOOL
Sabit, Cuyapo, Nueva Ecija
Fund Cluster
Original Copy/Photocopy: 06
CHECK: Payment for the purchase of load card
LIQUIDATION REPORT FOR THE MONTH OF:

JANUARY 2022 Check No. 0
REN-REN VARIETY STORE

NAMPICUAN, NUEVA ECIJA
Page 2 of 12
Region III
NUEVA ECIJA
Fund Cluster : 06
DISBURSEMENT VOUCHER Date: 01/30/2023
DV No. 2023-01-001
Mode of / MDS Check Commercial Check ADA Others (Please specify)

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee REN-REN VARIETY STORE
424-094-00001 2051
Address NAMPICUAN, NUEVA ECIJA
Particulars Responsibility Center MFO/PAP Amount

Payment for the purchase of load card
GROSS AMOUNT Php. 1,500.00
TAX WITHHELD
NON-VAT 1 % 15.00 1600 WB080 30.00
GOODS 1 % 15.00 0619-E WI640
Amount Due Php. 1,470.00
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.
ALFIE M. ANGEL
School Principal I
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)
one thousand four hundred seventy
Su
proper
Signature Signature
Printed MARIZA R. ALFONSO ALFIE M. ANGEL

Printed Name
Name
Position Disbursing Officer/Treasurer Position School Principal I
Date 01/30/2023 Date 01/30/2023

Page 2 of 12
E. Receipt of Payment JEV No.

Check/ Date : Bank Name & Account Number:
ADA No. : 0 01/30/2023 LANDBANK OF THE PHILIPPINES
Date : Printed Name: Date 01/30/2023
Signature :
01/30/2023 MARIA
MARINELA CARMELITA
V. UCOL G. RAMOS
Official Receipt No. & Date/Other 2051 01/30/2023
Documents
Page 3 of 12
Region III
NUEVA ECIJA
Date
01/30/2023
Original Copy/Photocopy:
OR/INVOICE RECEIPT: Payment for the purchase of load card

JANUARY 2022 OR/SI No. 2051

NAMPICUAN, NUEVA ECIJA
Page 4 of 12
Region III
NUEVA ECIJA
Original Copy/Photocopy:
PICTURE: Payment for the purchase of load card

JANUARY 2022
3
1
4
2
Page 5 of 12
Region III
NUEVA ECIJA
INSPECTION AND ACCEPTANCE REPORT
Fund Cluster : 06
Supplier : REN-REN VARIETY STORE IAR No. : 2023-01-001

PO No./Date : 2023-01-001 01/30/2023 Date : 01/30/2023
Requisitioning Office/Dept. : _______________________________ Invoice No. 2051
Responsibility Center Code : _______________________________ Date : 01/30/2023
Stock/
Description Unit Quantity
Property No.
1 load card P 300 card 5
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
INSPECTION ACCEPTANCE
Date Inspected : 01-30-2023 Date Received : 01/30/2023
Inspected, verified and found in Complete

order as to quantity and
specifications Partial (pls. specify quantity)
Team Leader: AURORA S. PASCUA

ROSE S. LANUZA
Regular Member: SINAMAR C. CONCEPCION Supply and/or Property Custodian
Provisional Member JOYCE ANN C. PASCUAL

Page 6 of 12
Region III
NUEVA ECIJA
PURCHASE ORDER
Supplier : REN-REN VARIETY STORE P.O. No. : 2023-01-001

Address : NAMPICUAN, NUEVA ECIJA Date : 01/30/2023
TIN: 424-094-00001 Mode of Procurement : GOODS
Gentlemen:
Please furnish this Office the following articles subject to the terms and conditions contained herein:
Place of Delivery :
D.R JOSE ELEMANTARY SCHOOL Delivery Term : COD
Date of Delivery : 01/30/2023 Payment Term : CHECK

Stock/
Unit Description Quantity Unit Cost Amount
Property No.
1 card load card P 300 5 300.00 1,500.00
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
(Total Amount in Words) one thousand five hundred Php. 1,500.00
In case of failure to make the full delivery within the time specified above, a penalty of one-tenth (1/10) of one percent for every
day of delay shall be imposed on the undelivered item/s.
Conforme: Very truly yours,
MARINELA V. UCOL ALFIE M. ANGEL

Signature over Printed Name of Supplier Signature over Printed Name of School
Principal/Teacher-in-Charge
01/30/2023 School Principal I
Page 6 of 12
Date Designation
Fund Cluster : 06 ORS/BURS No. 2051

Funds Available : MOOE Date of the ORS/BURS: 01/30/2023
MARIZA R. ALFONSO Amount : Php. 1,500.00

Signature over Printed Name of Disbursing
officer/School Treasurer
Page 7 of 12
Region III
NUEVA ECIJA
ABSTRACT OF CANVASS BID
FOR THE PURCHASE OF LOAD SUPPLIES
Held on 01/30/2023
REN-REN VARIETY STORE LADON'S COPY CENTER & GEN. MDSE

QTY UNIT ARTICLES
UNIT PRICE TOTAL UNIT PRICE TOTAL
5 card load card P 300 300.00 1,500.00 305.00 1,525.00
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
0 0 0 - - - -
0 0 0 - - - -
0 0 0 - - - -
0 0 0 - - - -
0 0 0 - - - -
0 0 0 - - - -
TOTAL 1,500.00 1,525.00
Recommending award to REN-REN VARIETY STORE

Prices considered just and reasonable and does not exceed the prices prevailing in the locality.
MARIZA R. ALFONSO ROSE S. LANUZA

Page 7 of 12
School Treasurer School Property Custodian

Page 7 of 12
Region III
NUEVA ECIJA
JOSE ELEMANTARY SCHOOL
ABSTRACT OF CANVASS BID
THE PURCHASE OF LOAD SUPPLIES
PHOTOPIX PRINTING
UNIT PRICE TOTAL

305.00 1,525.00
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
1,525.00

Prices considered just and reasonable and does not exceed the prices prevailing in the locality.
ALFIE M. ANGEL
Page 7 of 12
School Head
Page 8 of 12
Region III
NUEVA ECIJA
REQUEST FOR QUOTATION

Date: 01/30/2023
Quotation Reference Number: 2023-01-001
Sir/Madam:
Please quote your lowest price on the item/s listed below, stating the shortest time of delivery and submit your
quotation thru email at alfie.angel01@deped.gov.ph not later than 01/30/2023
JOYCE ANN C. PASCUAL ALFIE M. ANGEL

Canvasser Division Head
PROCUREMENT TERMS AND CONDITIONS
1. The Approved Budget for the Contract is PhP ________________________________
2. Price quoted are subject to deduction of 5% VAT & 1% EWT (for goods) or 5%VAT & 2%EWT (for services)
3. Goods, supplies, equipment or work done are subject to inspection/acceptance, DepED reserves the right to cancel
reject or rebid the items which do not conform with the specifications.
4. Complete technical specifications, brand & model must be indicated in the price quotation for evaluation purposes.
5. Delivery period shall be indicated in the quotation. A liquidated damages equivalent to 1/10 of 1% per day
of delay for the value of undelivered items shall be imposed.
6. All bids in excess of the ABC will be rejected.
7. Supplier warrants that he/she has not given nor promised to give any money or gift to any DepEd employee to
secure this offer and to obtain an award.
Item No. Quantity Unit Item and Description Unit Price Total Amount
1 5 card load card P 300
-
-
-
-
-
-
-
0 0 0 0.00 -
0 0 0 0.00 -
0 0 0 0.00 -
0 0 0 0.00 -
0 0 0 0.00 -
0 0 0 0.00 -
*************** Php.
Delivery Period: JANUARY 1-31, 2023
Warranty: 1 month after delivery
Price Validity: one month
Delivery Term: deliver
Payment Term: check payment/payment upon delivery
After having carefully read and accept your Procurement Terms & Conditions, I/We quote you on the item at prices
noted above.
FERDINAND F. SANGALANG
Page 8 of 12
PRINTED NAME/SIGNATURE
Designation: PROPRIETOR
Company Name: REN-REN VARIETY STORE

Business Address: NAMPICUAN NUEVA ECIJA
Telephone Number/CP number: N/A
Email Address: N/A
Page 9 of 12
Region III
NUEVA ECIJA

Date: 01/30/2023
Sir/Madam:

1. The Approved Budget for the Contract is PhP ________________________
-
-
-
-
-
-
-
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
*************** Php.
noted above.
AUGUSTO LADON
LADON'S COPY CENTER & GEN. MDSE

Company Name:
Business Address: CUYAPO, NUEVA ECIJA
Telephone Number/CP number: n/a
Email Address: N/A
Page 10 of 12
Region III
NUEVA ECIJA

Date: 01/30/2023
Sir/Madam:

1. The Approved Budget for the Contract is PhP ________________________
-
-
-
-
-
-
-
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
*************** Php.
noted above.
Page 10 of 12
ARNEL DE GRACIA
PHOTOPIX PRINTING
Company Name:
Business Address: CUYAPO, NUEVA ECIJA
Telephone Number/CP number: n/a
Email Address: N/A
Page 11 of 12
PURCHASE REQUEST
Entity Name: Department of Education Fund Cluster: 06
Office/Section PR. NO. 2023-01-001 Date: 01/30/2023

D.R JOSE ELEMANTARY
SCHOOL Responsibility Center Code:
Stock/ Property No. Unit Item Description Qty Unit Cost Total Cost
1 card load card P 300 5 300.00 1,500.00
-
-
-
-
-
-
-
0 0 0 0 0.00 -
0 0 0 0 0.00 -
0 0 0 0 0.00 -
0 0 0 0 0.00 -
0 0 0 0 0.00 -
0 0 0 0 0.00 -
TOTAL Php. 1,500.00
Purpose:
For school load supplies
#REF!
Requested by: Approved by:
Signature :
Printed Name : ROSE S. LANUZA ALFIE M. ANGEL

Page 11 of 12
Designation : Property Custodian School Principal I

Republic of the Philippines
For BIR BCS/ Department of Finance
Use Only Item: Bureau of Internal Revenue
BIR Form No.
Certificate of Creditable Tax
2307
January 2018 (ENCS)
Withheld at Source 2307 01/18ENCS
Fill in all applicable spaces. Mark all appropriate boxes with an "X".
1 For the Period From 01-01-2023 (MM/DD/YYYY) To 01-31-2023 (MM/DD/YYYY)
Part I – Payee Information
2 Taxpayer Identification Number (TIN) 424-094-00001

3 Payee’s Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)
4 Registered Address 4A ZIP Code
NAMPICUAN, NUEVA ECIJA 3117

5 Foreign Address, if applicable
Part II – Payor Information

6 Taxpayer Identification Number (TIN) 493-663-892-385
7 Payor’s Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)
8 Registered Address 8A ZIP Code
Sabit, Cuyapo, Nueva Ecija 3117

Part III – Details of Monthly Income Payments and Taxes Withheld
AMOUNT OF INCOME PAYMENTS
Income Payments Subject to Expanded Tax Withheld for the
ATC 1st Month of the 2nd Month of the 3rd Month of the
Withholding Tax Total Quarter
Quarter Quarter Quarter
Payment for the purchase of load card WB080 1,500.00 15.00
1 %
MONTHLY
0.01
Total
Money Payments Subject to Withholding
of Business Tax (Government & Private)
Payment for the purchase of load card WI640 1,500.00 15.00
1 %
MONTHLY
0.01
Total Php. 30.00

We declare under the penalties of perjury that this certificate has been made in good faith, verified by us, and to the best of our knowledge and belief, is true and
correct, pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof. Further, we give our consent
to the processing of our information as contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.
Date Signed (MM/DD/YYYY)

01/30/2023
275-596-995-000 ALFIE M. ANGEL
Signature over Printed Name of Payor/Payor’s Authorized Representative/Tax Agent
(Indicate Title/Designation and TIN)
Tax Agent Accreditation No./ Date of Issue Date of Expiry
Attorney’s Roll No. (if applicable) (MM/DD/YYYY) (MM/DD/YYYY)
CONFORME:
Date Signed (MM/DD/YYYY)
01/30/2023
424-094-00001 MARINELA V. UCOL
Signature over Printed Name of Payee/Payee’s Authorized Representative/Tax Agent
(Indicate Title/Designation and TIN)
Tax Agent Accreditation No./ Date of Issue Date of Expiry
Attorney’s Roll No. (if applicable) (MM/DD/YYYY) (MM/DD/YYYY)
*NOTE: The BIR Data Privacy is in the BIR website (www.bir.gov.ph)

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INPUTS ON BASIC INFORMATIONS (e-liquidation-tolitz2022-revised) - FOR GOODS/SERVICES

A. H E A D I N G - BASIC INFORMATIONS G. TAXES WITHHELD

B. DISBURSEMENT VOUCHER (DV) 65 ABSTRACT OF CANVASS BID: VAT SERVICES

18 CHECK NO.: 26 SCHOOL INSPECTION (ALL CAPS): SINAMAR D. CONCEPCION 69

37 PURPOSE (sCAPS): For school load supplies AMOUNT IN WORDS

F. REQUEST FOR QUOTATIONS - (ALL CAPS)

REN-REN VARIETY STORE 42 DESIGNATION: PROPRIETOR

43 COMPANY/BUSENESS NAME: REN-REN VARIETY STORE

44 BUSENESS ADDRESS: NAMPICUAN NUEVA ECIJA

LADON'S COPY CENTER & GEN. MDSE 48 DESIGNATION: PROPRIETOR

50 BUSENESS ADDRESS: CUYAPO, NUEVA ECIJA

52 e-MAIL ADDRESS: N/A

PHOTOPIX PRINTING 54 DESIGNATION: PROPRIETOR

55 COMPANY/BUSENESS NAME: PHOTOPIX PRINTING

56 BUSENESS ADDRESS: CUYAPO, NUEVA ECIJA

58 e-MAIL ADDRESS: N/A

CHECK: Payment for the purchase of load card

LIQUIDATION REPORT FOR THE MONTH OF:

REN-REN VARIETY STORE

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

Particulars Responsibility Center MFO/PAP Amount

REN-REN VARIETY STORE

GROSS AMOUNT Php. 1,500.00

C. Certified: D. Approved for Payment

Printed MARIZA R. ALFONSO ALFIE M. ANGEL

Date 01/30/2023 Date 01/30/2023

E. Receipt of Payment JEV No.

LIQUIDATION REPORT FOR THE MONTH OF:

REN-REN VARIETY STORE

LIQUIDATION REPORT FOR THE MONTH OF:

INSPECTION AND ACCEPTANCE REPORT

Supplier : REN-REN VARIETY STORE IAR No. : 2023-01-001

Inspected, verified and found in Complete

Team Leader: AURORA S. PASCUA

Provisional Member JOYCE ANN C. PASCUAL

Supplier : REN-REN VARIETY STORE P.O. No. : 2023-01-001

Date of Delivery : 01/30/2023 Payment Term : CHECK

Conforme: Very truly yours,

MARINELA V. UCOL ALFIE M. ANGEL

Fund Cluster : 06 ORS/BURS No. 2051

MARIZA R. ALFONSO Amount : Php. 1,500.00

REN-REN VARIETY STORE LADON'S COPY CENTER & GEN. MDSE

Recommending award to REN-REN VARIETY STORE

MARIZA R. ALFONSO ROSE S. LANUZA

School Treasurer School Property Custodian

UNIT PRICE TOTAL

REN-REN VARIETY STORE

REQUEST FOR QUOTATION

JOYCE ANN C. PASCUAL ALFIE M. ANGEL

Company Name: REN-REN VARIETY STORE

REQUEST FOR QUOTATION

JOYCE ANN C. PASCUAL ALFIE M. ANGEL

LADON'S COPY CENTER & GEN. MDSE

REQUEST FOR QUOTATION

JOYCE ANN C. PASCUAL ALFIE M. ANGEL

Entity Name: Department of Education Fund Cluster: 06

Office/Section PR. NO. 2023-01-001 Date: 01/30/2023

1 card load card P 300 5 300.00 1,500.00

Requested by: Approved by:

Printed Name : ROSE S. LANUZA ALFIE M. ANGEL

Designation : Property Custodian School Principal I

Part I – Payee Information

2 Taxpayer Identification Number (TIN) 424-094-00001

NAMPICUAN, NUEVA ECIJA 3117