Annex A1

Republic of the Philippines DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT Cordillera Administrative Region #40 North Drive, Baguio City
No.

OBLIGATION REQUEST
Payee Office Address
Responsibility Center

JUAN DELA CRUZ (Area of Assignment) (Area of Assignment)

Particulars P.P.A Account Code Amount

Payment of 40% traveling expenses for the month of _______________ amounting to

751

637.60

CHARGE to KC-MCC GOP 40%

Total
A.

637.60

Certified
Charges to appropriation/allotment necessary, lawful and under my direct supervision Supporting documents valid, proper and legal

B. Certified
Allotment available and obligated for the purpose as indicated above

Signature Printed Name Position Date EDNA T. DUHAN KC-RPC

Head, Requesting Office/Authorized Representative

Signature Printed Name Position Date FRANCIS A. KHAYAD Administrative Officer V

Head, Budget Unit/Authorized Representative

Annex A2

Republic of the Philippines DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT Cordillera Administrative Region #40 North Drive, Baguio City
No.

BUDGET UTILIZATION REQUEST

Payee Office Address
Responsibility Center

JUAN DELA CRUZ (Area of Assignment) (Area of Assignment)

Particulars
Account Code

Amount

Payment of 60% traveling expenses for the month of _________________ amounting to .

751

956.40

Charged to:KC-MCC-GRANT 60%

Total A. Certified B. Certified

956.40

Charges to budget necessary, lawful and under my direct supervision Supporting documents valid, proper and legal

Budget available and earmarked/utilized for the purpose as indicated above

Signature Printed Name Position

Signature

EDNA T. DUHAN
KC-RPC
Head, Requesting Office/Authorized Representative

Printed Name Position

FRANCIS A. KHAYAD
Administrative Officer V
Head, Budget Unit/Authorized Representative

Date

Date

Annex B

Republic of the Philippines DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT Cordillera Administrative Region #40 North Drive, Baguio City
No.

DISBURSEMENT VOUCHER
Mode of Payment Payee
MDS Check Commercial Check ADA Others

TIN/Employee No. JUAN DELA CRUZ

OR/BUR No.

Responsibility Center Address (Area of Assignment)

Office/Unit/Project Code

EXPLANATION

AMOUNT

Payment of 40% traveling expenses for the month of ________________ amounting to.

637.60

CHARGE to KC-MCC GOP 40%

637.60 A. Certified
Cash available

B. Approved for Payment Approved for Payment

Subject to Authority to Debit Account (when applicable) Supporting documents complete

Signature Printed Name Position

Signature

Printed Name

ISABEL SY NILLAS OIC-ARD/RPM Agency Head/Authorized Representative

RINA CLAIRE L. REYES Accountant III

Head Accounting Unit/Authorized Representative

Position Date

Date

C. Receipt of Payment Received Payment

Check/ ADA No.

Date Date

Bank Name JEV No. Printed Name Date

Signature Official Receipt/Other Documents

Annex B

Republic of the Philippines DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT Cordillera Administrative Region #40 North Drive, Baguio City
No.

DISBURSEMENT VOUCHER
Mode of Payment Payee
MDS Check Commercial Check ADA Others

TIN/Employee No. JUAN DELA CRUZ

OR/BUR No.

Responsibility Center Address (Area of Assignment)

Office/Unit/Project Code

KC-MCC

EXPLANATION

AMOUNT

Payment of 60% traveling expenses for the month of _________________ amounting to .

956.40

CHARGED to KC-MCC GRANT'60%

956.40 A. Certified
Cash available

B. Approved for Payment Approved for Payment

Subject to Authority to Debit Account (when applicable) Supporting documents complete

Signature Printed Name Position

Signature

RINA CLAIRE L. REYES Accountant III Head Accounting Unit/Authorized

Printed Name Position Date

ISABEL SY NILLAS OIC-ARD/RPM Agency Head/Authorized Representative JEV No.

Date C. Receipt of Payment Received Payment

Check/ ADA No.

Date Date

Bank Name Printed Name Date

Signature Official Receipt/Other Documents

Republic of the Philippines DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT Cordillera Administrative Region #40 North Drive, Baguio City

APPENDIX A

ITINERARY OF TRAVEL
NAME: JUAN DELA CRUZ POSITION: MFA Official Station: (indicate your area of assignment)

DATE:
MONTHLY SALARY: Residence:

Purpose of Travel: Attended the Workshop on KC-MCC processes

Date

Places to be visited Designation

TIME Depart Arrival

Means of Transpo

Fare

Per Diems MCC (60%)

CHARGING GOP (40%) Total

24-Apr-11 Residence to terminal Baguio Terminal to Cubao Terminal 25-Apr-11 Cubao Terminal to DSWD CO DSWD CO to Subic April 2629 At Subic 30-Apr-11 Subic to Victory terminal Victory Terminal to Baguio Baguio Terminal to Residence

10:05pm

10:40 AM 5:00am 9:00am

10:20pm 5:00am April 25, 2011) 5:30am 11:45am

taxi

75.00

45.00

30.00

75.00

PUB Taxi (shared) with service

445.00 75.00

240.00

411.00 45.00 -

274.00 30.00 94.00 179.60 30.00

685.00 75.00

235.00 449.00 75.00

3:00am 4:00am 11:00am

3:20am 11:00 AM 11:30am

Taxi (shared) PUB Taxi

75.00 449.00 75.00

160.00

141.00 269.40 45.00

Total

1,194.00

400.00

956.40

637.60

1,594.00

I certify that (1) have reviewed the foregoing itinerary, (2) that travel is necessary to the service (3) the period covered is reasonable and the expenses claimed are proper. (signed)
JUAN DELA CRUZ MFA

Approved by: (Head of Office)

EDNA T. DUHAN KC-RPC This form shall be attached to all claims for travelling expenses

ISABEL SY NILLAS OIC-ARD/RPM

This form was copied from the GOVERNMENT ACCOUNTING AND AUDITING MANUAL VOL. II

Republic of the Philippines DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT Cordillera Administrative Region #40 North Drive, Baguio City APPENDIX B DSWD-CAR, Baguio City Date: LEONARDO C. REYNOSO Regional Director I CERTIFY THAT I HAVE completed the travel authorized in the itinerary of Travell Order No.____ dated ___________________________ under condition indicated below: ____X_____Strictly in accordance with the approved itinerary _________Cut short as explained below. Excess payment in the amount of __________ was refunded under O.R. No. _________ dated ________________________. _________Extended as explained below. Additional itinerary was submitted. _________Other deviations as explained below. Explanations/Justifications: ____________________________________________________________________________________ ____________________________________________________________________________________. Evidence of Travel: ____X_____used tickets ____X _____Certificate of Appearance _____________Others: X Feedback report Respectfully yours, (signed)
JUAN DELA CRUZ

1/0/1900

RERs

On evidence and information of which I have knowledge, the travel was actually undertaken. EDNA T. DUHAN KC-RPC This form was copied from the GOVERNMENT ACCOUNTING AND AUDITING MANUAL VOLUME II page 351

General Form No. 2 Revised January 1992 REIMBURSEMENT EXPENSE RECEIPT Date No. RECEIVED from ______________________________________ (Name) of__________________________________________ the amount (Official Destination) 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: _____________________________________________ Residence Cert. No.: ___________________________________ Date of Issue: _________________________________________ Place of Issue: ________________________________________ WITNESS Name/Signature: _______________________________________ Address: _____________________________________________ Residence Cert. No.: ___________________________________ Date of Issue: _________________________________________ Place of Issue: ________________________________________

General Form No. 2 Revised January 1992 REIMBURSEMENT EXPENSE RECEIPT Date No. RECEIVED from ______________________________________ (Name) of__________________________________________ the amount (Official Destination) 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: _____________________________________________ Residence Cert. No.: ___________________________________ Date of Issue: _________________________________________ Place of Issue: ________________________________________ WITNESS Name/Signature: _______________________________________ Address: _____________________________________________ Residence Cert. No.: ___________________________________ Date of Issue: _________________________________________ Place of Issue: ________________________________________

General Form No. 2 Revised January 1992 REIMBURSEMENT EXPENSE RECEIPT Date No. RECEIVED from ______________________________________ (Name) of__________________________________________ the amount (Official Destination) 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: _____________________________________________ Residence Cert. No.: ___________________________________ Date of Issue: _________________________________________ Place of Issue: ________________________________________ WITNESS Name/Signature: _______________________________________ Address: _____________________________________________ Residence Cert. No.: ___________________________________ Date of Issue: _________________________________________ Place of Issue: ________________________________________

General Form No. 2 Revised January 1992 REIMBURSEMENT EXPENSE RECEIPT Date No. RECEIVED from ______________________________________ (Name) of__________________________________________ the amount (Official Destination) 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: _____________________________________________ Residence Cert. No.: ___________________________________ Date of Issue: _________________________________________ Place of Issue: ________________________________________ WITNESS Name/Signature: _______________________________________ Address: _____________________________________________ Residence Cert. No.: ___________________________________ Date of Issue: _________________________________________ Place of Issue: ________________________________________

DEPARTMENT OF SOCIAL WELFARE AND DEVT. DAILY TIME RECORD Payroll Period ___________________________

DEPARTMENT OF SOCIAL WELFARE AND DEVT. DAILY TIME RECORD Payroll Period ___________________________

DEPARTMENT OF SOCIAL WELFARE AND DEVT. DAILY TIME RECORD Payroll Period ___________________________

DEPARTMENT OF SOCIAL WELFARE AND DEVT. DAILY TIME RECORD Payroll Period ___________________________

Name:_____________________ Entity: KALAHI-CIDSS A.M. IN OUT IN P.M. OUT Late/ OT UT

Emp #:_____

Name:_____________________ Entity: KALAHI-CIDSS A.M. IN OUT IN P.M. OUT Late/ OT UT

Emp #:_____

Name:_____________________ Entity: KALAHI-CIDSS A.M. IN OUT IN P.M. OUT Late/ OT UT

Emp #:_____

Name:_____________________ Entity: KALAHI-CIDSS A.M. IN OUT IN P.M. OUT Late/ OT UT

Emp #:_____

Date

Remarks

Date

Remarks

Date

Remarks

Date

Remarks

Total Working Days: I certify on my honor that the above is a true and correct report of the hours of work performed, record of which was made daily at the time of arrival at and departure from office.

Total Working Days: I certify on my honor that the above is a true and correct report of the hours of work performed, record of which was made daily at the time of arrival at and departure from office.

Total Working Days: I certify on my honor that the above is a true and correct report of the hours of work performed, record of which was made daily at the time of arrival at and departure from office.

Total Working Days: I certify on my honor that the above is a true and correct report of the hours of work performed, record of which was made daily at the time of arrival at and departure from office.

Signature over Printed Name of the Employee

Signature over Printed Name of the Employee

Signature over Printed Name of the Employee

Signature over Printed Name of the Employee

Verified as to the prescribed office hours

Verified as to the prescribed office hours

Verified as to the prescribed office hours

Verified as to the prescribed office hours

Signature of the Immediate Supervisor

Signature of the Immediate Supervisor

Signature of the Immediate Supervisor

Signature of the Immediate Supervisor

Approved by:

Approved by:

Approved by:

Approved by:

ISABEL SY-NILLAS OIC-ARD/RPM

ISABEL SY-NILLAS OIC-ARD/RPM

ISABEL SY-NILLAS OIC-ARD/RPM

ISABEL SY-NILLAS OIC-ARD/RPM