Appendix 44

LIQUIDATION REPORT Serial No.: _________________

Period Covered ________________ Date: _____________________

Entity Name : PSHS CARC Responsibility Center Code:

Fund Cluster : 01 RAF __________________________

PARTICULARS AMOUNT

Cash Advance Amount

Less; Actual Expenses
Difference 0

TOTAL AMOUNT SPENT 0

AMOUNT OF CASH ADVANCE PER DV NO.______DTD. ______ 0
AMOUNT REFUNDED PER OR NO. ________DTD. ___________ 0
AMOUNT TO BE REIMBURSED 0
A Certified: Correctness of the B Certified: Purpose of travel / C Certified: Supporting
above data cash advance duly accomplished documents complete and proper

Signature
Name of Employee Name of Division Supervisor LEMUEL P. BANTIC
Designation Accountant II

JEV No.: ___________________

Date: ______________________ Date: _____________________ Date: _____________________

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