Apr - MOOE

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Name Name of School Agnecy

Address Address of School Account Code

Agency Agnecy Control No.

AGENCY PROCUREMENT REQUEST PS APR NO.

CENTRAL LUZON REGIONAL DEPOT

City of San Fernando, Pampanga

Please issue common use supplies/materials per PS Price List no.SFP-2611 as of April 11, 2011

Item No. ITEM and DESCRIPTION/SPECIFICATION QTY. UNIT UNIT PRICE AMOUNT

1 -

2 -

3 -

4 -

5 -

6 - 7 -

8 -

9 -

10 -

11 -

12 -

13 -

14 -

15 -

16 -

17 -

18 -

19 -

20 -

TOTAL AMOUNT -

Stocks requested are certified Funds Certified Available: Approved:to be within approved program:

Name of Principal LOLITA D. ALVARO NICOLAS T. CAPULONG, Ph. D.

Principal Accountant II Assistant Schools Div. Supt.- OIC

Fund deposited with PS ( ) Check No. _________ in the amount of __________

_________________________________________ (P ____________ ) enclosed.

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Republic of the Philippines

Department of Education - PAMPANGA

DISBURSEMENT VOUCHER MODE OF PAYMENT

Payee/ Office: ANTONIO M. GUECO JR. TIN/ Employee No.: OS/BUS No.:

Name of Princi al

Responsibility Center:

Title: Code:

To cash advance to defray payment of office supplies of

school: Name o Sc oo

address: A ress o Sc oo

Certified: Supporting documents complete and proper Approved for Payment:

Cash available

Subject to ADA

Signature: __________________________ Signature: ______________________________________

Printed Name: LEILA C. ESTIOCO Printed Name: ROMEO M. ALIP, Ph. D., CESO V Position: Accountant II Position: Schools Division Superintendent

Date: __________________________ Date: ___________________________

Received Payment: Journal Entry Voucher:

Check/ADA No.:_____________________

Signature: _____________________________ Date:______________ Date:________________________ No.: _________________

Printed Name: Bank Name: ___________________

OR No./other relevant document Date: ________________

Issued:

Address: Address of School

Particulars Amount

No.:

MDS Check Commercial Check ADA OthersDate:

-P

Name of Principal

Date:

A B

C D

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Annex G-3

Payee/Office Name of Principal

Department of Education - BATAAN Date:

ACCOUNTING ENTRIES

Debit Credit

Subsidy to Implementing Units 873 -

Cash 108 -

Prepared by: Certified Correct:

BESSIE M. MENA LEILA C. ESTIOCO

Senior Bookkeeper Accountant II

Annex G-3

Payee/Office Name of Principal


ACCOUNTING ENTRIES

Debit Credit


Cash 108 -


BESSIE M. MENA LEILA C. ESTIOCO

Senior Bookkeeper Accountant II

JOURNAL ENTRY VOUCHER No.

Amount

JOURNAL ENTRY VOUCHER No.

Responsibility

Center Accounts and Explanation Account

Code P

Responsibility

Center Accounts and Explanation Account

CodeP

Amount

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Department of EducationDIVISION OF PAMPANGA

Payee/ Office: No.:

Date:

Address: Responsibility Center:

AccountCode

Amount

Office Supplies Expense 755 -

-P

Certified: Charges to appropriation/ allotment necessary, lawful Certified: Appropriation/ Allotment available and obligated for

and under my direct supervision. the purpose as indicated above.

Signature: Signature:

Printed Name: Printed Name: LEILA C. ESTIOCO

Position: Position: Accountant II

Date: Date:


Department of EducationDIVISION OF BATAAN

Payee/ Office: No.:

Date:

Address: Responsibility Center:

Account

Code Amount

Office Supplies Expense 755 - 0 0 - 0 0 - 0 0 -

-P

Certified: Charges to appropriation/ allotment necessary, lawful Certified: Appropriation/ Allotment available and obligated for

and under my direct supervision. the purpose as indicated above.

Signature: Signature:

Printed Name: Printed Name: LEILA C. ESTIOCO

Position: Position: Accountant II

Date: Date:

Schools Division Superintendent

OBLIGATION SLIP

Name of School

Address of School

Particulars

A. Requested by: B. Funds Available

A. Requested by: B. Funds Available

_____________________________ __________________________________

ROMEO M. ALIP, Ph. D., CESO V

_____________________________ __________________________________

OBLIGATION SLIPName of School

Address of School

Particulars

Schools Division Superintendent

_____________________________ __________________________________

_____________________________ __________________________________


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PURCHASE ORDER Department of Education - DIVISION OF BATAAN

Supplier PROCUREMENT SERVICES P.O. No. ______________

Address Pampanga Date ______________

Mode of Procurement ______________

Gentlemen:

Please furnish this office the following articles subject to the terms and conditions contained herein:

Place of Delivery: Name of School Delivery Term: ______________

Date of Delivery: ________________________________ Payment Term: ______________

Item No. Quantity Unit Description Unit Cost Amount

1 0 0 0 - -

2 0 0 0 - -

3 0 0 0 - -

4 0 0 0 - -

5 0 0 0 - -

6 0 0 0 - -

7 0 0 0 - -

8 0 0 0 - -

9 0 0 0 - -

10 0 0 0 - -

11 0 0 0 - -

12 0 0 0 - -

13 0 0 0 - -

14 0 0 0 - -

15 0 0 0 - -

16 0 0 0 - -

17 0 0 0 - -

18 0 0 0 - -

19 0 0 0 - -

20 0 0 0 - -

(Total Amount in Words) Sub-Total -

In case of failure to make the full delivery within the time specified above, a penalty of one-tenth (10) of one percent

for every day of delay shall be imposed.

Conforme: Very truly yours,

PROCUREMENT SERVICES ROMEO M. ALIP, Ph. D., CESO V

Dealer Schools Division Superintendent

Signature over printed name

_________________________

Date

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INSPECTION & ACCEPTANCE REPORTDepartment of Education - DIVISION OF BATAAN

Supplier CRISSCROSS TRADING & CONSTRUCTION SUPPLY AR No. ______________________

P.O. No. Date : _____________

Requisitioning Office/Dept. : Dinalupihan, Bataan Date ______________ Invoice No. ___________

Item No. Unit Description Quantity

1 0 0 0

2 0 0 0

3 0 0 0

4 0 0 0

5 0 0 0

6 0 0 0

7 0 0 0

8 0 0 0

9 0 0 0

10 0 0 0

11 0 0 0

12 0 0 0

13 0 0 0

14 0 0 0

15 0 0 0

16 0 0 0

17 0 0 0

18 0 0 0

19 0 0 0

20 0 0 0

INSPECTION ACCEPTANCE

Date Inspected: ________________________ Date Received: ________________________

inspected, verified and found OK Completed

as to quantity and specifications

Partial

Name of Head School BAC Name of School Property CustodianHead, School BAC School Property Custodian

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Appendix 58

LIQUIDATION REPORT No.:

Department of Education - BATAAN Date

Agency Responsibilty Center

Code

PARTICULARS Amount

To liquidate cash advance re: school supplies of

NAME OF SCHOOL

Address of School

Total Mount Spent -

Amount of cash advance per DV No. _______ Dated _________ -

Amount refunded per O.R. No. __________ Date ____________

Amount to be reimbursed -


Appendix G3

Payee/Office

No.:


ACCOUNTING ENTRIES

Amount

Debit Credit

Office Supplies Expense 755 -



BESSIE M. MENA

Senior Bookkeeper

A. Certified: Correctness of the above dataB. Certified: Purpose of travel/cash advance

duly accomplihed

C. Certified: Supporting documents complete and

proper

Name of Principal LEILA C. ESTIOCOClaimant Immediate Supervisor Accountant II

Accountant II

Name of Principal

JOURNAL ENTRY VOUCHER

Responsibility

Center Accounts and Explanation

Account

CodeP

LEILA C. ESTIOCO

Documents

Apr - MOOE