Name Address Agency

Name of School Address of School

Agnecy Account Code Agnecy Control No.

AGENCY PROCUREMENT REQUEST CENTRAL LUZON REGIONAL DEPOT City of San Fernando, Pampanga

PS APR NO.

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 to be within approved program: Funds Certified Available: Approved:

Name of Principal Principal

LOLITA D. ALVARO Accountant II

NICOLAS T. CAPULONG, Ph. D. Assistant Schools Div. Supt.- OIC

Fund deposited with PS ( ) Check No. _________ in the amount of __________ _________________________________________ (P ____________ ) enclosed.

Republic of the Philippines Department of Education - PAMPANGA

DISBURSEMENT VOUCHER
MODE OF PAYMENT
No.:

MDS Check
Payee/ Office:

Commercial Check

ADA

Others
TIN/ Employee No.:

ANTONIO M. GUECO JR. Name of Principal

Address of School
Particulars

Date: OS/BUS No.:

Address:

Date: Responsibility Center: Title: Code:

Amount

To cash advance to defray payment of office supplies of

school: address:

Name of School Address of School

P
A

Certified:

Supporting documents complete and proper Cash available Subject to ADA

Approved for Payment:

Signature: Printed Name: Position: Date:

__________________________
LEILA C. ESTIOCO
Accountant II

Signature: Position: Date:

________________________________________

Printed Name:

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

Schools Division Superintendent

__________________________

___________________________
D

Received Payment:
Check/ADA No.:_____________________ _____________________________ Date:______________ Date:________________________ Bank Name: ___________________ OR No./other relevant document Issued:

Journal Entry Voucher:

No.: _________________ Date: ________________

Signature: Printed Name:

Name of Principal

Annex G-3 Payee/Office Name of Principal

JOURNAL ENTRY VOUCHER

Department of Education - BATAAN
Responsibility Center Accounts and Explanation Account Code

No. Date: ACCOUNTING ENTRIES P Amount Debit Credit

Subsidy to Implementing Units Cash

873 108

Prepared by: BESSIE M. MENA Senior Bookkeeper

Certified Correct: LEILA C. ESTIOCO Accountant II

Annex G-3 Payee/Office Name of Principal

JOURNAL ENTRY VOUCHER

Department of Education - BATAAN
Responsibility Center Accounts and Explanation Account Code

No. Date: ACCOUNTING ENTRIES P Amount Debit Credit

Subsidy to Implementing Units Cash

873 108

Prepared by: BESSIE M. MENA Senior Bookkeeper

Certified Correct: LEILA C. ESTIOCO Accountant II

Republic of the Philippines Department of Education DIVISION OF PAMPANGA

OBLIGATION SLIP
Payee/ Office: Address: Name of School No.: Date: Responsibility Center:

Address of School Particulars

Account Code

Amount

Office Supplies Expense

755

P
A. Requested by:
Certified: Charges to appropriation/ allotment necessary, lawful and under my direct supervision.
Signature: Printed Name: Position: Date:

B. Funds Available
Certified: Appropriation/ Allotment available and obligated for the purpose as indicated above.
Signature: Printed Name: Position: Date:

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

__________________________________ LEILA C. ESTIOCO

Schools Division Superintendent

Accountant II
__________________________________

_____________________________

Republic of the Philippines Department of Education DIVISION OF BATAAN

OBLIGATION SLIP
Payee/ Office: Address: Name of School No.: Date: Responsibility Center:

Address of School Particulars

Account Code

Amount

Office Supplies Expense 0 0 0

A. Requested by:
Certified: Charges to appropriation/ allotment necessary, lawful and under my direct supervision.
Signature: Printed Name: Position: Date:

755 0 0 0 P
B. Funds Available
the purpose as indicated above.
Signature: Printed Name: Position: Date:

Certified: Appropriation/ Allotment available and obligated for

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

__________________________________ LEILA C. ESTIOCO

Schools Division Superintendent

Accountant II
__________________________________

_____________________________

PURCHASE ORDER
Department of Education - DIVISION OF BATAAN
Supplier Address Gentlemen: Please furnish this office the following articles subject to the terms and conditions contained herein: Place of Delivery: Date of Delivery: Item No. Quantity PROCUREMENT SERVICES Pampanga P.O. No. Date Mode of Procurement ______________ ______________ ______________

Name of School ________________________________

Unit Description

Delivery Term: Payment Term: Unit Cost

______________ ______________ Amount

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 Dealer Signature over printed name _________________________ Date Requisitioning Office/Dept. Name of Principal Principal Authorized Official LEILA C. ESTIOCO Chief Accountant Funds Available:

ROMEO M. ALIP, Ph. D., CESO V Schools Division Superintendent

Amount ALOBS No.

________________ ________________

INSPECTION & ACCEPTANCE REPORT

Department of Education - DIVISION OF BATAAN
Supplier P.O. No. Requisitioning Office/Dept. : Item No.

CRISSCROSS TRADING & CONSTRUCTION SUPPLY Dinalupihan, Bataan

Unit Date ______________ Description

AR No. ______________________ Date : _____________ Invoice No. ___________ Quantity

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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
Date Inspected: ________________________

ACCEPTANCE
Date Received: ________________________

inspected, verified and found OK as to quantity and specifications

Completed Partial

Name of Head School BAC

Head, School BAC

Name of School Property Custodian

School Property Custodian

Appendix 58

LIQUIDATION REPORT Department of Education - BATAAN

Agency

No.: Date 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 A. Certified: Correctness of the above data B. Certified: Purpose of travel/cash advance duly accomplihed

C. Certified: Supporting documents complete and proper

Name of Principal
Claimant

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

Immediate Supervisor

LEILA C. ESTIOCO
Accountant II

Appendix G3 Payee/Office Name of Principal

JOURNAL ENTRY VOUCHER

Department of Education - BATAAN
ACCOUNTING ENTRIES
Responsibility Center

No.: Date:

Accounts and Explanation

Account Code

P Debit

Amount Credit

Office Supplies Expense Subsidy to Implementing Units

755 873

Prepared by: BESSIE M. MENA Senior Bookkeeper

Certified Correct: LEILA C. ESTIOCO Accountant II