Republic of the Philippines

Department of Education
Region V
DIVISION OF SORSOGON
Sorsogon

Fund Cluster :
Entity Name
Date :
DISBURSEMENT VOUCHER DV No. :

Mode of MDS Check Commercial Check ADA Others (Please specify)

Payment
_________________

Payee TIN/Employee No.: ORS/BURS No.:

Address

Responsibility
Particulars MFO/PAP Amount
Center

Amount Due
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

________________________________________
Printed Name, Designation and Signature of Supervisor

B. Accounting Entry:
Account Title UACS Code Debit Credit

C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applica
Supp
proper

Signature Signature

Printed
Printed Name
Name

92
 Position Head, Accounting Unit/Authorized Position
Agency Head/Authorized Representative
Representative
Date Date

E. Receipt of Payment JEV No.

Check/ Date : Bank Name & Account
ADA No. : Number:
Signature : Date : Printed Name: Date

Official Receipt No. & Date/Other Documents

92
 Republic of the Philippines
Department of Education
Region V
DIVISION OF SORSOGON
Sorsogon

Fund Cluster :

Date :
DV No. :

_________________
ORS/BURS No.:

Amount

ance necessary, lawful and incurred under my direct supervision.

______________________________________
ed Name, Designation and Signature of Supervisor

Credit

92
Agency Head/Authorized Representative

92
 Republic of the Philippines
Department of Education
Region V
DIVISION OF SORSOGON
Sorsogon

LIQUIDATION REPORT
Period Covered ________________

Entity Name : _____________________________________________

Fund Cluster : _____________________________________________

PARTICULARS

TOTAL AMOUNT SPENT

AMOUNT OF CASH ADVANCE PER DV NO.______DTD. ______
AMOUNT REFUNDED PER OR NO. ________DTD. ___________
AMOUNT TO BE REIMBURSED
A Certified: Correctness of th Certified: Purpose of travel /
 above data cash advance duly accomplished

________________________ ________________________
Signature over Printed Name Signature over Printed Name
Claimant Immediate Supervisor

Date: _____________________Date: _____________________

 the Philippines
nt of Education
egion V
OF SORSOGON
rsogon

Serial No.: _________________

Date: _____________________

Responsibility Center Code:

__________________________

AMOUNT

Certified: Supporting documents complete and proper

 Certified: Supporting documents complete and proper

________________________
Signature over Printed Name
Head, Accounting Division Unit

JEV No.: ___________________

Date: _____________________
 Republic of the Philippines
Department of Education
Region V
DIVISION OF SORSOGON
Sorsogon

PURCHASE REQUEST

Entity Name: _______________________ Fund Cluster: _________________

Office/Section : _____________ PR No.: ______________ Date: ____________
Responsibility Center Code :
_________________________ ___________

Stock/ Property No. Unit Item Description Quantity Unit Cost Total Cost

Purpose: ____________________________________________________________
_______________________________________________________________
_______________________________________________________________

Requested by: Approved by:

___________________ ____________________
Signature :
______
___________________ _______
____________________
Printed Name :
______ _______
Designation : ___________________ ____________________
______ _______
 Republic of the Philippines
Department of Education
Region V
DIVISION OF SORSOGON
Sorsogon

PURCHASE ORDER
______________________
Entity Name

Supplier : _______________________________P.O. No. : ____________________________

Address : ________________________________Date : _______________________________
TIN : __________________________________ Mode of Procurement : _________________
Gentlemen:
Please furnish this Office the following articles subject to the terms and conditions contained herein:

Place of Delivery : ______________________ Delivery Term : ________________________

Date of Delivery : ________________________ Payment Term : ________________________

Stock/ Property No. Unit Description Quantity 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 on the undelivered item/s.

Conforme: Very truly yours,

 __________________________ ________________________________
Signature over Printed Name of Supplier Signature over Printed Name of Authorized Official
___________________________ _____________________________
Date Designation

Fund Cluster : __________________________ ORS/BURS No. : ______________________

Funds Available : ________________________ Date of the ORS/BURS: _______________
Amount : ____________________________
________________________________________
Signature over Printed
Name of Chief
Accountant/Head of
 Republic of the Philippines
Department of Education
Region V
DIVISION OF SORSOGON
Sorsogon

REQUISITION AND ISSUE SLIP

Entity Name : __________________________________ Fund Cluster : ______________________

Division : _____________________________________ Responsibility Center Code : ______________________

Office : _______________________________________ RIS No. : _____________________________________
Requisition Stock Available? Issue
Stock No. Unit Description Quantity Yes No Quantity

Purpose:

Requested by:
Approved by: Issued by:
Signature :
Printed Name :
Designation :
Date :
AO 6/15/02
 s
n

E SLIP

Fund Cluster : ______________________

Center Code : ______________________

__________________________________
Issue
Remarks

Received by:
 Republic of the Philippines
Department of Education
Region V
DIVISION OF SORSOGON
Sorsogon

INSPECTION AND ACCEPTANCE REPORT

Entity Name : ______________________________ Fund Cluster : ___________

Supplier : ______________________________________________ IAR No. : _______________

PO No./Date : ___________________________________________ Date : _________________
Requisitioning Office/Dept. : _______________________________ Invoice No. : ____________
Responsibility Center Code : _______________________________ Date : _________________

Stock/
Description Unit Quantity
Property No.

INSPECTION ACCEPTANCE
Date Inspected : ________________________ Date Received : _____________________

Inspected, verified and found in order as to quantity Complete

and specifications
Partial (pls. specify
quantity)

____________________________________________ ___________________________________
Inspection Officer/Inspection Committee Supply and/or Property Custodian
 Republic of the Philippines
Department of Education
Region V
DIVISION OF SORSOGON
Sorsogon

INVENTORY CUSTODIAN SLIP

Entity Name: _________________________________

Fund Cluster : ________________________________ ICS No : ______________

Amount
Inventory
Quantity Unit Unit Total Description
Item No.
Cost Cost
Received from:
__________________________________
Signature Over Printed Name
__________________________________
Position/Office
__________________________________
Date
Received by:
______________________________
Signature Over Printed Name
______________________________
Position/Office
______________________________
Date
No : ______________

Estimated Useful
Life
______________________
ure Over Printed Name
______________________
Position/Office
______________________
Date
 Republic of the Philippines Republic of th
Department of Education Department
Region V Reg
DIVISION OF SORSOGON DIVISION OF
Sorsogon Sors

ACKNOWLEDGEMENT RECEIPT ACKNOWLEDG

DATE : ____________________________ RECEIPT NO.: ________________ DATE : _________________

AMOUNT RECEIVED FROM : ____________________________________________________________________ AMOUNT RECEIVED FROM : ______________________
ADDRESS : ____________________________________________________________________ ADDRESS : ______________________
____________________________________________________________________ ______________________
AMOUNT : ____________________________________________________________________ AMOUNT : ______________________
PURPOSE OF PAYMENT : ____________________________________________________________________ PURPOSE OF PAYMENT : ______________________

ACCOUNT PAYMENT MADE BY ACCOUNT

TOTAL AMOUNT DUE : CASH TOTAL AMOUNT DUE :
AMOUNT PAID : CHECK AMOUNT PAID :
BALANCE DUE : OTHERS BALANCE DUE :

AMOUNT RECEIVED BY : ____________________________________________________________________ AMOUNT RECEIVED BY : ______________________

_________________________________ _____________________________________ _________________________________

AUTHORIZED SIGNATURE AUTHORIZED SIGNATURE AUTHORIZED SIGNATURE
 Republic of the Philippines
Department of Education
Region V
DIVISION OF SORSOGON
Sorsogon

ACKNOWLEDGEMENT RECEIPT

_________________RECEIPT NO.: ________________

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

PAYMENT MADE BY
CASH
CHECK
OTHERS

____________________________________________________________________

_____________________________________
AUTHORIZED SIGNATURE
 Republic of the Philippines
Department of Education
Region V
DIVISION OF SORSOGON
Sorsogon

BAC Resolution No. 33, S. 2016 Recommending the Use of Negotiated Small Value as
Mode of Procurement

WHEREAS, Request for Qoutations for the following Purchase Requests are listed
below has an Approved Budget for the Contract (ABC):

Purchase Request (PR) Number DATE AMOUNT

NOW, THEREFORE, We, the members of the School Bids and Awards Committee, hereby
RESOLVE as it is hereby RESOLVED:

1. That since the above stated Purchase Requests are below the threshold of Five Hundred
Thousand Pesos (Php. 500,000.00), we recommend that the Negotiated Small Value
Mode of Procurement be used;

2. Approval by the School Head of (Name of School and District) is hereby recommended.

RESOLVED, at this Office, this ____th day of ______________________, 2016.

___________________________________
BAC Chairperson

____________________________ ___________________________________
BAC Vice Chairperson BAC Member

____________________________ ___________________________________
BAC Member BAC Member

Approved by:
________________________________________
School Head