Voucher & Other Forms

Annex B
Republic of the Philippines

De-Ed-CAR, Division of Mountain province
Bauko District I
GOTANG PRIMARY SCHOOL
DISBURSEMENT VOUCHER
MODE OF
PAYMENT
PAYEE
MDS CHECK
NO.
Commercial Check ADA Others

TIN/Employee No.
OR/BUR No.
Address
Responsibility Center
Office/Unit/Project
Code
EXPLANATION
AMOUNT
Gross Amount:__________________________
Less: Withholding Tax____________________
Net Amount:____________________________
A. Certified
B. Approved for Payment
Cash Available
Subject to Authority to Debit Account
(When applicable)
Supporting documents complete
Signature
Signature
LEONOR M. BAGNOS
Printed Name
School Treasurer
Position
Position
Date
Date
Received Payment ____________Date ____________
_____________________________
Signature Over Printed Name
ISABEL M. BALACOA
Cluster Head
JEV No.

Dep-Ed- CAR, Division of Mountain Province
Bauko District I
NO.___________________________________
DATE: _________________________________
MODE OF PAYMENT
______ Cash
______Commercial Check
Name of Claimant:
Employee No.
_____ADA
______Others
ID No./TIN:
ADDRESS:
PARTICULARS
AMOUNT
AMOUNT DUE
A.
CERTIFIED Expenses/cash
Advance necessary lawful
And enccured my direct supervision
B. APPROVED FOR PAYMENT
ISABEL M. BALACOA
School Head
LEONOR M. BAGNOS
School Treasurer
_________________
Date
C.. Received Payment P________Date _________
___________________________
ALOBS No.________ Date:________

JEV No.___________ Date:________
PURCHASE ORDER
Supplier:____________________________
Address: _____________________________
TIN: ___________________
P.O.
Date: _________________
Mode of Procurement ________
Gentlemen:
Please furnish this office the following articles subject to the terms and conditions contained
Place of delivery: _________________________ Delivery Term:_________________
Date of Delivery:________________________
Payment Term ________________
Stock
No.
1
Unit
Quantity
DESCRIPTION
Pcs.
Soccer ball
Unit Cost
Amount
TOTAL AMOUNT IN WORDS:

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.
Conforme:
_________________________________
Signature Over Printed Name of Supplier
Date:___________________________
Funds Available:
APPROVED:
ISABEL M. BALACOA
School Head
ALOBS No.: ______________________
Amount: __________________________
ITINERARY OF TRAVEL
Name: _______________________
PURPOSE OF TRAVEL: _________________________________________________
______________________________________________________________________
Date
Place to be Visited
TIME
Departure
EXPENSES
arrival
Means
of Trans
TOTAL
(2) The travel is necessary to the service (3) the
Period covered is reasonable and (4) the
expenses claimed are proper
Transportation
Total
Amount
Per-diem
__________________
Official Employee
Recommending Approval:
ALFREDO B. DALANG
District Supervisor
APPROVED:
SALLY B. ULLALIM, CESO
Assistant Schools Division Superintendent

Officer In-Charge
Annex B
Bauko District I
MODE OF
PAYMENT
PAYEE
NO.
MDS CHECK Commercial Check ADA Others

SALOME C. EVAN
TIN/Employee No.
OR/BUR No.
Address
Office/Unit/Project
Code
EXPLANATION
AMOUNT
Reimbursement payment of school electric bill
P165.73
Gross Amount:__________________________
Net Amount:____________________________
A. Certified
Cash Available
(When applicable)
Signature
Signature
LEONOR M. BAGNOS
Printed Name
School Treasurer
Position
Position
Date
Date
Received Payment P 195.17 Date 03/27/15
LEONOR M. BAGNOS
ISABEL M. BALACOA
Cluster Head
JEV No.
Annex B
Bauko District I
MODE OF
PAYMENT
PAYEE
NO.

ISABEL M. BALACOA
TIN/Employee No.
OR/BUR No.
Address
Office/Unit/Project
Code
EXPLANATION
AMOUNT
Reimbursement payment of refill ink & manila paper
P710.00
Gross Amount:__________________________
Net Amount:____________________________
A. Certified
Cash Available
(When applicable)
Signature
Signature
LEONOR M. BAGNOS
Printed Name
School Treasurer
Position
Position
Date
Date
Received Payment P710.00 Date 12/09/2014
ISABEL M. BALACOA
ISABEL M. BALACOA
Cluster Head
JEV No.
Annex B
Bauko District I
MODE OF
PAYMENT
PAYEE
NO.

ISABEL M. BALACOA
TIN/Employee No.
OR/BUR No.
Address
Office/Unit/Project
Code
EXPLANATION
AMOUNT
Reimbursement payment of pilot pentel pen
P140.00
Gross Amount:__________________________
Net Amount:____________________________
A. Certified
Cash Available
(When applicable)
Signature
Signature
LEONOR M. BAGNOS
Printed Name
School Treasurer
Position
Position
Date
Date
Received Payment P 140 Date 12/13/2014
ISABEL M. BALACOA
ISABEL M. BALACOA
Cluster Head
JEV No.
Annex B
Bauko District I
MODE OF
PAYMENT
PAYEE
NO.

LEONOR M. BAGNOS
TIN/Employee No.
OR/BUR No.
Address
Office/Unit/Project
Code
EXPLANATION
AMOUNT
Reimbursement payment of registration fee of Salome Evan
P1000.00
Gross Amount:__________________________
Net Amount:____________________________
A. Certified
Cash Available
(When applicable)
Signature
Signature
LEONOR M. BAGNOS
Printed Name
School Treasurer
Position
Position
Date
Date
Received Payment P 1000 Date 12/09/2014
SALOME C. EVAN
ISABEL M. BALACOA
Cluster Head
JEV No.
Annex B
Bauko District I
MODE OF
PAYMENT
PAYEE
NO.

ISABEL M. BALACOA
TIN/Employee No.
OR/BUR No.
Address
Office/Unit/Project
Code
EXPLANATION
AMOUNT
Reimbursement payment of 1 card load
P300.00
Gross Amount:__________________________
Net Amount:____________________________
A. Certified
Cash Available
(When applicable)
Signature
Signature
LEONOR M. BAGNOS
Printed Name
School Treasurer
Position
Position
Date
Date
ISABEL M. BALACOA
ISABEL M. BALACOA
Cluster Head
JEV No.
Annex B
Bauko District I
MODE OF
PAYMENT
PAYEE
NO.

SALOME C. EVAN
TIN/Employee No.
OR/BUR No.
Address
Office/Unit/Project
Code
EXPLANATION
AMOUNT
P400.00
Reimbursement for payment of travel expenses of Salome Evan
Gross Amount:__________________________
Net Amount:____________________________
A. Certified
Cash Available
(When applicable)
Signature
Signature
LEONOR M. BAGNOS
Printed Name
School Treasurer
Position
Position
Date
Date
SALOME C. EVAN
ISABEL M. BALACOA
Cluster Head
JEV No.

DedEd CAR, Division of Mountain Province
Bauko District I
Bagnen Elementary School
SUMMARY OF CASH DISBURSEMENT
Period Covered: Month January and February 2012
Date
Received
Name of Payee
Nature 0f Payment
DV#
Forwarded Balance
For the month of
Jan. and Feb.
01-14-12
02-06-12
02-06-12
Alimayo
Domanas
Isabel Balacoa
Cash
Advance
Disbursement
Gotang/Primary School
DV#
Cash
Advance
Disbursement
Balan
ce
537.69
8,337.70
7,800.01
Photo of grade V1
test questions and
other forms
Reimbursement for
the photocopying of
grades I and II test
questions
Balance
12-01-01
369.00
7,968.70
331.75
7,636.95
`
12-01-03
Isabel Balacoa
Reimbursement
12-01-03
250.00
7,386.95
of refill ink
02-07-12
Amelia
Reimbursement
Sudaypan
for the payment
12-01-04
262.48
7,124.47
of Electric bill
THIS IS TO CERTIFY that this report of Disbursement for the month of January, 2012 is true and correct statement of the disbursement made by
the cluster school in the total amount pf Php8,337.70 for Bagnen Elementary School while Gotang Primary School made disbursement with a total
amount of Php.__________. The remaining balance is Php.7,124.47 for Bagnen E;lementary school and ________________ for Gotang Primary
School.
ISABEL M. BALACOA
Cluster Head
INSPECTION AND ACCEPTANCE REPORT

Division of Mountain Province
Supplier:
________________________________
IAR No. __________________
PO:_______________Date:________________Invoice No.:_______________Date:________________
Office/Department:
Stock
No.
Dep-Ed
Unit
Description
INSPECTION
Quality
ACCEPTANCE
Date Inspection:_____________________________
Date Received:___________
Inspected, verified and found in order as to quantity and specifications.
___ Complete
___ Partial (Pls. specify quantity)
LEONOR M. BAGNOS
School Treasurer/Teacher I
GIMMA G. TICGONGAN
PTA Treasurer
JULIA D. GANSOWEN
SGC Treasurer
ISABEL M. BALACOA
Inspection Officer
INSPECTION AND ACCEPTANCE REPORT

Division of Mountain Province
Supplier:
________________________________
IAR No. __________________
PO:_______________Date:________________Invoice No.:_______________Date:________________
Office/Department:
Stock
No.
Dep-Ed
Unit
Description
INSPECTION
Quality
ACCEPTANCE
Date Inspection:_____________________________
Date Received:___________
Inspected, verified and found in order as to quantity and specifications.
___ Complete
LEONOR M. BAGNOS
Inspection Officer
___ Partial (Pls. specify quantity)
AMELIA G. SUDAYPAN
Inspection Officer
WILSON P. MONDATA
Inspection Officer
SALOME C. EVAN
Inspection Officer
ABSTRUCT OF BIDS/QUOTATION OPENED ON___________AT 1M/PM IN THE OFFICE OF THE SCHOOLS DIVISION
SUPERINTENDENT, MOUNTAIN PROVINCE,DIVISION, BONTOC MOUNTAINPROVINCE (FOR IN THE OFFICE OF THE DIVISION
OF MOUNTAIN PROVINCE)
Item No.
Quantity
Unit
Item Description
(Name of Bidders and the corresponding amount of the Item)
W HEREBY CERTIFY THAT the above quotations ere opened by us at exactly_________AM/PM_________,20_________ at the office
of the schools Division Superintendent
____________________________
_______________________
Superintendent Representative
Auditors Representative
DECISION OF THE COMMITTEE ON AWARDS
AWARD RECOMMENDED TO:________________________ FOR Items No._________to______________for the Items No._______________
To_____________________for the Items No._________to_____________the prices being lowest and most advantages.
___________________________
Chairman
APPROVED:
_______________________
Member
_____________________________
Member
CONCURRED IN:
____________________________
_________________________

Bauko District I
Period Covered: Month June, 2012
Date
Received
Name of Payment
DV#
Name of Payee
Cash
Advance
04-19-12
05-08-12
06-06-12
05-22-12
05-22-12
06-03-12
06-06-12
MOOE allocation for the month of April

MOOE allocation for the month of May
12-04-699
12-05-882
Isabel M. Balacoa
Isabel M. Balacoa
6,000.00
3,000.00
Balance forwarded
Reimbursement of vulca seal payment
Reimbursement of nail payment
Payment of District Electric Bill
Payment of office supply
Cash
Received
262.54
12-05-026
Cash
Disbursed
Total Cash
balance
9,262.54
9,002.54
8,142.54
7,745.14
6,855.14
Isabel M. Balacoa
260
Isabel M. Balacoa
860
Isabel M. Balacoa
397.40
Ms Grocery&Gen.
890
Mechandise
06-06-12
Payment of school report card
12-06-030 Concepcion Atitew
30
6,825.14
06-17-12
Payment of folder and bond paper
12-06-031
Ms grocery&Gen.
940
5,885.14
Merchanise
06-22-12
Continuous ink and canon ink no. 830 12-06-032
JJ and Marketing
2,150
3,735.14
06-22-12
Printing colored pictures
12-06-033
Mini Haus
144
3,591.14
Computer and
Xerox shop
06-23-12
Payment of assorted dental medicine
12-06-034
Polymed dental
3,175
416.14
Center
06-29-12
School Electric bill
12-06-035
MOPRECO
347.53
68.61
THIS IS TO CERTIFY that this report of Disbursement for the month of June, 2012 is true and correct statement of the disbursement made by the
cluster school in the total amount of 9,262.54 for Bagnen Elementary School. The remaining balance is Php.68.61 .
12-05-027
12-06-028
12-06-029
ISABEL M. BALACOA
Cluster Head

Bauko District I
Gotang Primary School
Period Covered: Month June, 2012
Date
Received
Name of Payment
DV#
06-06-12
04-19-12
05-08-12
06-16-12
Balance forwarded
MOOE allocation for the month of April
MOOE allocation for the month of May
Assorted school and office supply
06-20-12
12-06-013
06-23-12
Payment of plastic cover and masking

tape
Payment of assorted Dental Medicine
06-29-12
Payment of school electric bill
12-06-015
Name of Payee
Cash
Advance
Cash
Received
Cash
Disbursed
Total Cash
balance
1,000.00
4941.96
3941.96
980.00
2961.96
1962.00
999.96
162.72
837.24
941.96
12-04-699
12-05-882
12-06-012
12-06-014
Isabel M. Balacoa
Isabel M. Balacoa
Ms Grocery and
Gen. Merchandise
Polymed Dental
Center
MOPRECO
3,000.00
1,000.00
THIS IS TO CERTIFY that this report of Disbursement for the month of June, 2012 is true and correct statement of the disbursement made by
the cluster school in the total amount of Php 4941.96 for Gotang Primary School. The remaining balance is Php. 837.24.
ISABEL M. BALACOA
Cluster Head

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Annex B

Republic of the Philippines

Commercial Check ADA Others

Republic of the Philippines

B. APPROVED FOR PAYMENT

C.. Received Payment P________Date _________

ALOBS No.________ Date:________

TOTAL AMOUNT IN WORDS:

Assistant Schools Division Superintendent

MDS CHECK Commercial Check ADA Others

Reimbursement payment of school electric bill

MDS CHECK Commercial Check ADA Others

Reimbursement payment of refill ink & manila paper

MDS CHECK Commercial Check ADA Others

Reimbursement payment of pilot pentel pen

MDS CHECK Commercial Check ADA Others

Reimbursement payment of registration fee of Salome Evan

MDS CHECK Commercial Check ADA Others

Reimbursement payment of 1 card load

MDS CHECK Commercial Check ADA Others

Republic of the Philippines

INSPECTION AND ACCEPTANCE REPORT

IAR No. __________________

Inspected, verified and found in order as to quantity and specifications.

INSPECTION AND ACCEPTANCE REPORT

IAR No. __________________

Inspected, verified and found in order as to quantity and specifications.

___ Partial (Pls. specify quantity)

(Name of Bidders and the corresponding amount of the Item)

Republic of the Philippines

MOOE allocation for the month of April

Republic of the Philippines

Payment of plastic cover and masking

Payment of school electric bill

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C.. Received Payment PDate _

ALOBS No. Date: