FOR TEV

TRAVEL OUTSIDE REGION 12 TRAVEL WITHIN REGION 12

1 Obligation Request 4 copies 1 Obligation Request 4 copies

2 Voucher 3 copies 2 Voucher 3 copies
3 Itinerary of Travel 3 copies 3 Itinerary of Travel 3 copies
(Back to back A & B) (Back to back A & B)
4 DPO (Dept. Personnel Order) 4 Regional Personnel Order
5 Regional Personnel Order 5 Certificate of Appearance Orginal copy
6 Certificate of Appearance Orginal copy 6 Narrative Report
7 Boarding pass photocopy Per diem:
8 Terminal fee Orginal copy 300.00 Incidental 150.00/meal
9 Narrative Report 750.00 accommodation

TRAVEL OUTSIDE REGION 12 TRAVEL WITHIN REGION 12

1 Obligation Request 4 copies 1 Obligation Request 4 copies

2 Voucher 3 copies 2 Voucher 3 copies
3 Itinerary of Travel 3 copies 3 Itinerary of Travel 3 copies
(Back to back A & B) (Back to back A & B)
4 DPO (Dept. Personnel Order) 4 Regional Personnel Order
5 Regional Personnel Order 5 Certificate of Appearance Orginal copy
6 Certificate of Appearance Orginal copy 6 Narrative Report
7 Boarding pass photocopy Per diem:
8 Terminal fee Orginal copy 300.00 Incidental 150.00/meal
9 Narrative Report 750.00 accommodation

TRAVEL OUTSIDE REGION 12 TRAVEL WITHIN REGION 12

1 Obligation Request 4 copies 1 Obligation Request 4 copies

2 Voucher 3 copies 2 Voucher 3 copies
3 Itinerary of Travel 3 copies 3 Itinerary of Travel 3 copies
(Back to back A & B) (Back to back A & B)
4 DPO (Dept. Personnel Order) 4 Regional Personnel Order
5 Regional Personnel Order 5 Certificate of Appearance Orginal copy
6 Certificate of Appearance Orginal copy 6 Narrative Report
7 Boarding pass photocopy Per diem:
8 Terminal fee Orginal copy 300.00 Incidental 150.00/meal
9 Narrative Report 750.00 accommodation
 APPENDIX B

Republic of the Philippines

Department of Health
CENTER FOR HEALTH DEVELOPMENT - SOCCSKSARGEN Region
Cotabato City

CERTIFICATE OF TRAVEL COMPLETED

Date:

I CERTIFY that I have completed the travel authorized in the iterenary

No. dated under conditions indicated
below:

( x ) - Strictly in accordance with the approved iterenary

( ) - Cut short as explained below; excess payment in the amount of

was refunded in Official Receipt No.
dated

( )- Extended as explained below:

Explainations or justifications

Evidence of travel attached

Appendix A & B, CHD Order, CERTIFICATE OF APPEARANCE

Respectfully submitted

ALEIAH JEAN L. LIBATIQUE, RPh

DMO - lV

On evidence and information that which I have knowledge, the travel was
actually undertaken.

RUBELITA H. AGGALUT, MD, MCH

DMO - V / PDOHO
 Appendix 45
ITINERARY OF TRAVEL

Entity Name : DOH-RO XII

Fund Cluster: SAA No. 2023-02 - 000490 No.
Name : ALEIAH JEAN L. LIBATIQUE, RPh Date of Travel : May 2- June 15, 2023
Position : PHARMACIST II Purpose of Travel : PDOHO Order No.
Official Station: Amas, Kidapawan city Conduct of Intra -campaign monitoring & provide
Technical Assistance during the MR-OPV SIA
Date Places to be visited TIME Means of Paid Per Total
(2023)
(Destination) Depart Arrival Transpo Diem Amount
May-02 Stn Amas- Brgy Tinimbacan 6:00 a.m 8:45 a.m hired van charge 750.00 750.00
Tinimbacan - RHU Banisilan 11:00 a.m 11;30 a.m hired van to DOH -
RHU- Brgy Gastav, Banisilan 1:30 p.m 2;10 p.m hired van CHD XII
Banisilan - Stn Amas 4:30 p.m 6:30 p.m hired van
May-03 Stn Amas - Brgy Saguing, Makilala 6:30 a.m 7:30 a.m hired van 750.00 750.00
Brgy Saguing- RHU Makilala 9;30 a.m 10:00 a.m hired van
RHU-Brgy Kisante Makilala 10:35 a.m 10:55 a.m hired van
Kisante - RHU Magpet 1:30 p.m 2:10 p.m hired van
RHU- Brgy Poblacion 3:20 p.m 3;40 p.m hired van
Brgy Pob Magpet - Stn Amas 5:30 p.m 6:30 p.m hired van
May-04 Stn Amas- RHU Arakan 6:00 a.m 7:30 a.m hired van 750.00 750.00
RHU Arakan - Brgy Napalico 8:10 a.m 9:10 a.m hired van
Napalico - Brgy Malatab, Antipas 11:00 a.m 11:45 a.m hired van
Malatab -Brgy Pontevedra, Antipas 1:20 p.m 1:45 p.m hired van
Pontevedra - RHU Antipas 3:15 p.m 4:00 p.m hired van
Antipas - Stn Amas 5:00 p.m 6:30 p.m hired van
May-05 Stn Amas - RHU Pikit 6:30 a.m 7:30 a.m hired van 750.00 750.00
RHU -Brgy Ginatilan 9:30 a.m 10:00 a.m hired van
Brgy Inug-og- Brgy Ladtinagn 1:30 p.m 2:00 p.m hired van
Brgy Pob.Pikit - RHU Kabacan 3:30 p.m 4:10 p.m hired van
RHU Kabacan - Stn Amas 5:30 p.m 6:45 p.m hired van
May-09 Stn Amas-RHU Libungan 750.00 750.00
RHU- Brgy Montay
Brgy Montay- Brgy Grebona
Bry Grebona- RHU Alamada
RHU- Brgy Polayagan
Brgy Polayagan - Brgy Rangayen
Brgy Rangayen- Stn Amas
May-10 Stn Amas-Brgy Taguranao, Matalam 6:00 a.m 8:30 a.m hired van 750.00 750.00
Taguranao - Brgy Arakan 10:00 a.m 10:20 a.m hired van
Arakan - Brgy Tamped 12:00 nn 12:30 nn hired van
Brgy Tamped - Brgy Sta. Maria 2:00 p.m 2:45 p.m hired van
Sta. Maria - Lampayan 3:50 p.m 4:10 p.m hired van
Lampayan - Stn Amas 5:45 p.m 6:15 p.m hired van
May-11 Stn Amas - RHU Tulunan 6:00 a.m 7:00 a.m hired van 750.00 750.00
RHU Tulunan - Brgy Tambac 8:30 a.m 9:15 a.m hired van
Brgy Tambac - Poblacion 10:00 a.m 10:20 a.m hired van
Brgy Poblacion - Brgy Sibsib 11:30 a.m 12:00 nn hired van
Brgy Sibsib - Brgy Banayal 1:30 p.m 2:00 p.m hired van
Brgy Banayal - Stn Amas 3:00 p.m 3:20 p.m hired van
Sub Total 5,250.00 ₱5,250.00
I certify that : (1) I have reviewed the foregoing itinerary, Prepared by :
(2) the travel is necessary to the service, (3) the period
covered is reasonable and (4) the expenses claimed
are proper.
I certify that : (1) I have reviewed the foregoing itinerary,
(2) the travel is necessary to the service, (3) the period
covered is reasonable and (4) the expenses claimed
ALEIAH JEAN L. LIBATIQUE, RPh
are proper.
Signature over Printed Name
Approved by:

RUBELITA H. AGGALUT, MD, MCH ARISTIDES CONCEPCION TAN, MD, MPH, CESO III
DMO V/Provincial DOH Officer Director IV
Appendix 45
ITINERARY OF TRAVEL

Entity Name : DOH-RO XII

Fund Cluster: SAA No. 2023-02 - 000490 No.

Name : MARELYN Q. GONZALES,C.E Date of Travel : May 2- June 15, 2023

Position : DMO IV Purpose of Travel :
Official Station: Amas, Kidapawan city Conduct of Intra -campaign monitoring & provide
Technical Assistance during the MR-OPV SIA
Date Places to be visited TIME Means of Paid Per Total
(2023)
(Destination) Depart Arrival Transpo Diem Amount
Sub- Total 4,500.00 4,500.00
May-12 Stn Amas -RHU Midsayap 6:00 a.m 8:00 a.m hired van charge 750.00 750.00
RHU - Brgy Upper Glad I 9:00 a.m 9:30 a.m hired van to DOH -
Upper Glad I - Upper Glad 2 11:30 a.m 12:00 nn hired van CHD XII
Uppler Glad 2 - Central Bulanan 1:00 p.m 1:30 p.m hired van
Brgy. Central Bulanan - Pob 8 3:40 p.m 3:55 p.m hired van
Brgy Pob 8 - Stn Amas 5:00 p.m 6:45 p.m hired van
May-23 Stn Amas -Brgy Bagolibas, Aleosan 6:00 a.m 7:30 a.m hired van 750.00 750.00
Bagolibas, Brgy Pagangan 9:00 a.m 9:20 a.m hired van
Pagangan - Lower Mingading 12:00 nn 12:45 p.m hired van
Lower Mingading - New Leon 2:45 p.m 3:10 p.m hired van
New Leon - RHU Aleosan 4:40 p.m 5:10 p.m hired van
Aleosan - Stn Amas 5:20 p.m 6:30 p.m hired van
May-24 Stn Amas- Brgy Magatos, Kabacan 6:30 a.m 7:30 a.m hired van 750.00 750.00
Magatos - Kilagasan 9:30 a.m 10:00 a.m hired van
Kaligasan - Osias 12:00 nn 12:20 nn hired van
Osias - Katidtuan 2:00 p.m 2:20 p.m hired van
Katidtuan - RHU Kabacan 3:45 p.m 4:10 p.m hired van
Kabacan - Stn Amas 5:30 p.m 6:20 p.m hired van
May-25 Stn Amas -RHU Arakan 6:00 a.m 7:20 a.m hired van 750.00 750.00
RHU - Brgy Gambudes 9:00 a.m 11:30 a.m hired van
Brgy Gambudes,Arakan - Stn Amas 3:30 p.m 6:30 p.m hired van
May-26 Stn Amas - Bituan 6:30 a.m 8:00 a.m hired van charge 750.00 750.00
Bituan - Tuburan 11:00 a.m 12:00 nn hired van to DOH -
Tuburan - RHU Tulunan 3:00 p.m 3:45 p.m hired van CHD XII
Tulunan - Stn Amas 5:20 p.m 6:30 p.m hired van
May-29 Stn Amas-Brgy Central Katingawan 6:00 a.m 8:45 a.m hired van 750.00 750.00
Central Katingawan-RHU Midsayap 1:00 p.m 1:45 p.m hired van
RHU Midsayap - Stn Amas 4:00 p.m 6:30 p.m hired van
May-30 Stn Amas - Brgy Pob ,Pikit 6:30 a.m 7:30 a.m hired van 750.00 750.00
Brgy Pob- RHU Pikit 1:00 p.m 1:20 p.m hired van
RHU Pikit - Stn Amas 5:00 p.m 6:00 p.m hired van

Sub Total 7,500.00 ₱7,500.00

I certify that : (1) I have reviewed the foregoing itinerary, Prepared by :
(2) the travel is necessary to the service, (3) the period
covered is reasonable and (4) the expenses claimed
are proper.
I certify that : (1) I have reviewed the foregoing itinerary,
(2) the travel is necessary to the service, (3) the period
covered is reasonable and (4) the expenses claimed
MARELYN Q. GONZALES
are proper.
Signature over Printed Name
Approved by:

RUBELITA H. AGGALUT, MD, MCH ARISTIDES CONCEPCION TAN, MD, MPH, CESO III
DMO V/Provincial DOH Officer Director IV
Appendix 45
ITINERARY OF TRAVEL

Entity Name : DOH-RO XII

Fund Cluster: SAA No. 2023-02 - 000490 No.

Name : MARELYN Q. GONZALES,C.E Date of Travel : May 2- June 15, 2023

Position : DMO IV Purpose of Travel :
Official Station: Amas, Kidapawan city Conduct of Intra -campaign monitoring & provide
Technical Assistance during the MR-OPV SIA
Date Places to be visited TIME Means of Paid Per Total
(2023)
(Destination) Depart Arrival Transpo Diem Amount
May-31 Stn Amas-Brgy Manubuan,Matalam 6:30 a.m 7:00 a.m hired van 450.00 450.00
Brgy Manubuan - RHU Matalam 12:00 nn 12:30 nn hired van
RHU Matalam - Stn Amas 3:30 p.m 4:00 p.m hired van
Jun-01 Stn Amas - Brgy Kiaring, Banisilan 6:00 a.m 10:00 a.m hired van 750.00 750.00
Brgy Kiaring - Brgy Thailand 1:00 p.m 2:00 p.m hired van
Brgy Thailand - RHU Banisilan 3:30 p.m 4:10 p.m hired van
RHU Banisilan - STn Amas 4:30 p.m 7:00 p.m hired van
Jun-02 Stn Amas -Mun. Hall Carmen 6:00 a.m 7:00 a.m hired van 750.00 750.00
Mun. Hall - Brgy. Kibudtungan 7:45 a.m 8:10 a.m hired van
Kibudtungan - RHU Carmen 1:00 p.m 1:30 p.m hired van
RHU Carmen - Stn Amas 4:30 p.m 6:00 p.m hired van

Sub Total 1,950.00 ₱1,950.00

I certify that : (1) I have reviewed the foregoing itinerary, Prepared by :
(2) the travel is necessary to the service, (3) the period
covered is reasonable and (4) the expenses claimed
MARELYN Q. GONZALES
are proper.
Signature over Printed Name
covered is reasonable and (4) the expenses claimed
are proper.

Approved by:

RUBELITA H. AGGALUT, MD, MCH ARISTIDES CONCEPCION TAN, MD, MPH, CESO III
DMO V/Provincial DOH Officer Director IV

Appendix 45
ITINERARY OF TRAVEL

Entity Name : DOH-RO XII

Fund Cluster: SAA No. 2023-02 - 000490 No.

Name : MARELYN Q. GONZALES,C.E Date of Travel : April 11- 14, 2023

Position : DMO IV Purpose of Travel : PDOHO Order No.
Official Station: Amas, Kidapawan city To provide technical assistance and pre campaign
readiness assessment for MR-OPV SIA
Date Places to be visited TIME Means of Paid Per Total
(2023)
(Destination) Depart Arrival Transpo Diem Amount
Apr-12 Stn Amas- RHU Alamada 6:00 a.m 8:45 a.m hired van charged to 750.00 750.00
Alamada - RHU Aleosan 10:30 a.m 12:30 nn hired van OH -CHD XII
Aleosan - Stn Amas 3:00 p.m 5:30 p.m hired van

Apr-14 Stn Amas - RHU Banisilan 6:00 a.m 9:00 a.m hired van 750.00 750.00
Banisilan - RHU Carmen 11:30a.m 1:30 p.m hired van
Carmen - RHU Kabacan 3:00 p.m 3:30 p.m hired van
Kabacan - Stn Amas 5:00 p.m 6:45 p.m hired van

Sub Total ₱0.00 750.00 ₱750.00

I certify that : (1) I have reviewed the foregoing itinerary, Prepared by :
(2) the travel is necessary to the service, (3) the period
covered is reasonable and (4) the expenses claimed
MARELYN Q. GONZALES
are proper.
Signature over Printed Name
covered is reasonable and (4) the expenses claimed
are proper.

Approved by:

RUBELITA H. AGGALUT, MD, MCH ARISTIDES CONCEPCION TAN, MD, MPH, CESO III
DMO V/Provincial DOH Officer Director IV

Appendix 45
ITINERARY OF TRAVEL

Entity Name : DOH-RO XII

Fund Cluster: PDOHO-Cotabato Province No.

Name : MARELYN Q. GONZALES,C.E Date of Travel : April 25 -28, 2023

Position : DMO IV Purpose of Travel : RPO No. 1325
Official Station: Amas, Kidapawan city Attendance to theConsultative Meeting with Chiefs
of Hosp. and other Stakeholders
Date Places to be visited TIME Means of Paid Per Total
(2023)
(Destination) Depart Arrival Transpo Diem Amount
Jan .4 Stn Amas- Pikit 8:50 a.m 10:05 a.m PUV ₱250.00 150.00 400.00
Pikit - Stn Amas 1:00 p.m 2:30 p.m PUV 250.00 250.00
Jan. 5 Stn Amas - Matalam 8:00 a.m 8:30 a.m PUV 50.00 150.00 200.00
Matalam - Tulunan 8:50 a.m 10:00 a.m PUV 85.00 85.00
Tulunan Sibsib - RHU 10:05 a.m 10:25 a.m PUV 15.00 15.00
RHU - Sibsib Tulunan 3:35 p.m 4:10 p.m PUV 15.00 15.00
Tulunan - Matalam 4:20 p.m 5;20 p.m PUV 85.00 85.00
Matalam - Stn Amas 5:30 p.m 6:00 p.m PUV 50.00 50.00
Jan 11 Stn Amas- Aleosan 7:30 a.m 9:00 a.m PUV 300.00 150.00 450.00
Aleosan - Pikit 2:00 p.m 2:30 p.m PUV 60.00 60.00
Pikit - Stn Amas 4:00 p.m 5:20 p.m PUV 250.00 250.00
Jan 12 Stn Amas - Matalam 8:00 a.m 8:30 a.m PUV 50.00 150.00 200.00
Matalam - Tulunan 8:50 a.m 10:00 a.m PUV 85.00 85.00
Tulunan Sibsib - RHU 10:05 a.m 10:25 a.m PUV 15.00 15.00
RHU - Sibsib Tulunan 3:35 p.m 4:10 p.m PUV 15.00 15.00
Tulunan - Matalam 4:20 p.m 5;20 p.m PUV 85.00 85.00
Matalam - Stn Amas 5:30 p.m 6:00 p.m PUV 50.00 50.00
Jan13 Stn Amas - Matalam 7:00 a.m 7:30 a.m PUV 50.00 150.00 200.00
Matalam - Sibsib,Tulunan 7:50 a.m 9:00 a.m PUV 85.00 85.00
hired
150.00
Sibsib - Brgy Maybula 9:10 a.m 9:40 a.m motor 150.00
hired
150.00
Brgy Maybula -Sibsib 4:30 p.m 5:00 p.m motor 150.00
Jan 17 Stn Amas - Aleosan 7:14 a.m 9:00 a.m PUV 300.00 150.00 450.00
Aleosan - Stn Amas 3:40 p.m 5:15 p.m PUV 300.00 300.00
Jan 18 Stn Amas - Pob Kid (Manuel Hos ) 8:00 a.m 8:30 a.m PUV 60.00 60.00
Manuel Hosp - Madonna Hosp 10:30 a.m 10:40 a.m
Madonna Hosp - Stn amas 2:30 p.m 3:00 p.m PUV 60.00 60.00
Jan 19 Stn Amas - Pob (United Doctors ) 9:00 a.m 9:30 a.m PUV 60.00 60.00
United Doctors Pob - Stn Amas 11:30 a.m 12:00 nn PUV 60.00 60.00

Sub Total ₱2,735.00 750.00 ₱3,485.00

I certify that : (1) I have reviewed the foregoing itinerary, Prepared by :
(2) the travel is necessary to the service, (3) the period
covered is reasonable and (4) the expenses claimed
are proper.
I certify that : (1) I have reviewed the foregoing itinerary,
(2) the travel is necessary to the service, (3) the period
covered is reasonable and (4) the expenses claimed
MARELYN Q. GONZALES
are proper.
Signature over Printed Name
Approved by:

RUBELITA H. AGGALUT, MD, MCH ARISTIDES CONCEPCION TAN, MD, MPH, CESO III
DMO V/Provincial DOH Officer Director IV

TOTAL ₱0.00 - ₱0.00

I certify that : (1) I have reviewed the foregoing itinerary, Prepared by :
(2) the travel is necessary to the service, (3) the period
covered is reasonable and (4) the expenses claimed
MARELYN Q. GONZALES
are proper.
Signature over Printed Name
Approved by:

RUBELITA H. AGGALUT, MD, MCH ARISTIDES CONCEPCION TAN, MD, MPH, CESO III
DMO V/Provincial DOH Officer Director IV

Appendix 45
ITINERARY OF TRAVEL

Entity Name : DOH-RO XII

Fund Cluster: PDOHO-Cotabato Province No.

Name : MARELYN Q. GONZALES,C.E Date of Travel : Feb. 1,21,22,23,28, 2023 ,

Position : DMO IV Mar 1,2,3, 2023
Official Station: Amas, Kidapawan city Purpose of Travel : Regular task as DOH Rep
and other functions, attached special order
Date Places to be visited TIME Means of Paid Per Total
(2023)
(Destination) Depart Arrival Transpo Diem Amount
Feb-01 Stn Amas - Matalam 8:00 a.m 8:30 a.m PUV 50.00 150.00 200.00
Matalam - Tulunan 8:50 a.m 10:00 a.m PUV 85.00 85.00
Tulunan Sibsib - RHU 10:05 a.m 10:25 a.m PUV 15.00 15.00
RHU - Sibsib Tulunan 3:35 p.m 4:10 p.m PUV 15.00 15.00
Tulunan - Matalam 4:20 p.m 5;20 p.m PUV 85.00 85.00
Matalam - Stn Amas 5:30 p.m 6:00 p.m PUV 50.00 50.00
Feb-21 Stn Amas - Aleosan 7:14 a.m 9:00 a.m PUV 300.00 150.00 450.00
Aleosan - Stn Amas 3:40 p.m 5:15 p.m PUV 300.00 300.00
Feb-22 Stn Amas - Matalam 8:00 a.m 8:30 a.m PUV 50.00 150.00 200.00
Matalam - Tulunan 8:50 a.m 10:00 a.m PUV 85.00 85.00
Tulunan Sibsib - RHU 10:05 a.m 10:25 a.m PUV 15.00 15.00
RHU - Sibsib Tulunan 3:35 p.m 4:10 p.m PUV 15.00 15.00
Tulunan - Matalam 4:20 p.m 5;20 p.m PUV 85.00 85.00
 Matalam - Stn Amas 5:30 p.m 6:00 p.m PUV 50.00 50.00
Feb-23 Stn Amas - Aleosan 7:14 a.m 9:00 a.m PUV 300.00 150.00 450.00
Aleosan - Stn Amas 3:40 p.m 5:15 p.m PUV 300.00 300.00
Feb-28 Stn Amas - Tulunan 3:30 p.m 4:10 p.m Hired van -
Tulunan - Sta. Amas 5:15 p.m 6:00 p.m Hired van
Mar-01 Stn Amas - Aleosan 7:14 a.m 9:00 a.m PUV 300.00 150.00 450.00
Aleosan - Stn Amas 3:40 p.m 5:15 p.m PUV 300.00 300.00
Mar-02 Stn Amas - Matalam 8:00 a.m 8:30 a.m PUV 50.00 150.00 200.00
Matalam - Tulunan 8:50 a.m 10:00 a.m PUV 85.00 85.00
Tulunan Sibsib - RHU 10:05 a.m 10:25 a.m PUV 15.00 15.00
RHU - Sibsib Tulunan 3:35 p.m 4:10 p.m PUV 15.00 15.00
Tulunan - Matalam 4:20 p.m 5;20 p.m PUV 85.00 85.00
Matalam - Stn Amas 5:30 p.m 6:00 p.m PUV 50.00 50.00
Mar-03 Stn Amas- Pikit 8:50 a.m 10:05 a.m PUV ₱250.00 150.00 400.00
Pikit - Stn Amas 1:00 p.m 2:30 p.m PUV 250.00 250.00

TOTAL ₱3,200.00 1,050.00 ₱4,250.00

I certify that : (1) I have reviewed the foregoing itinerary, Prepared by :
(2) the travel is necessary to the service, (3) the period
covered is reasonable and (4) the expenses claimed
MARELYN Q. GONZALES
are proper.
Signature over Printed Name
Approved by:

RUBELITA H. AGGALUT, MD, MCH ARISTIDES CONCEPCION TAN, MD, MPH, CESO III
DMO V/Provincial DOH Officer Director IV

Appendix 45
ITINERARY OF TRAVEL

Entity Name : DOH-RO XII

Fund Cluster: PDOHO-Cotabato Province No.

Name : MARELYN Q. GONZALES,C.E Date of Travel : Mar. 8, 27,28,29,30, 2023 ,

Position : DMO IV
Official Station: Amas, Kidapawan city Purpose of Travel : Regular task as DOH Rep
and other functions, attached special order
Date Places to be visited TIME Means of Paid Per Total
(2023)
(Destination) Depart Arrival Transpo Diem Amount
Mar-08 Stn Amas - Matalam 8:00 a.m 8:30 a.m PUV 50.00 50.00
Matalam - Tulunan 8:50 a.m 9:20 a.m PUV 85.00 85.00
Tulunan Sibsib - RHU 9:30 a.m 9:55 a.m PUV 15.00 15.00
RHU - Sibsib Tulunan 3:35 p.m 3:55 p.m PUV 15.00 15.00
Tulunan - Matalam 4:20 p.m 5:00 p.m PUV 85.00 85.00
Matalam - Stn Amas 5:10 p.m 5:40 p.m PUV 50.00 50.00
Mar 27, Stn Amas - Matalam 8:00 a.m 8:30 a.m PUV 50.00 50.00
Matalam - Tulunan 8:50 a.m 9:20 a.m PUV 85.00 85.00
Tulunan Sibsib - RHU 9:30 a.m 9:55 a.m PUV 15.00 15.00
RHU - Sibsib Tulunan 3:35 p.m 3:55 p.m PUV 15.00 15.00
Tulunan - Matalam 4:20 p.m 5:00 p.m PUV 85.00 85.00
Matalam - Stn Amas 5:10 p.m 5:40 p.m PUV 50.00 50.00
Mar-28 Stn Amas - Matalam 7:00 a.m 7:30 a.m PUV 50.00 50.00
 Matalam - Tulunan 7:50 a.m 8:40 a.m PUV 85.00 85.00
Tulunan Sibsib - Brgy Poblacion 8:50 a.m 9:00 a.m PUV 15.00 15.00
Brgy Poblacion - Sibsib Tulunan 9:10 a.m 9:25 a.m PUV 15.00 15.00
Tulunan - Matalam 9:35 a.m 10:05a.m PUV 85.00 85.00
Matalam - Aleosan 10:15 a.m 11:20 a.m PUV 250.00 150.00 400.00
Aleosan - Stn Amas 4:00 p.m 5:30 p.m PUV 250.00 250.00
Mar 29 Stn Amas - Aleosan 8:00 a.m 9:30 a.m PUV 300.00 150.00 450.00
Aleosan - Stn Amas 3:40 p.m 5:15 p.m PUV 300.00 300.00
Mar 30, Stn Amas- Pikit 8:50 a.m 10:05 a.m PUV 250.00 150.00 400.00
Pikit - Stn Amas 1:00 p.m 2:30 p.m PUV 250.00 250.00

TOTAL ₱2,450.00 450.00 ₱2,900.00

I certify that : (1) I have reviewed the foregoing itinerary, Prepared by :
(2) the travel is necessary to the service, (3) the period
covered is reasonable and (4) the expenses claimed
MARELYN Q. GONZALES
are proper.
Signature over Printed Name
Approved by:

RUBELITA H. AGGALUT, MD, MCH ARISTIDES CONCEPCION TAN, MD, MPH, CESO III
DMO V/Provincial DOH Officer Director IV
hiefs
 Republic of the Philippines
Department of Health
REGIONAL OFFICE XII Fund Cluster : SAA NO.
Cotabato City 2023-02-000490
Date :
DISBURSEMENT VOUCHER DV No. :

Mode of
MDS Check Commercial Check
Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee Aleiah Jean L. Libatique, RPh

Address Amas, Kidapawan City

Particulars Responsibility Center MFO/PAP Amount

To payment of travelling expenses as of 1,950.00

May 2 to June 15, 2023 in the amount of……

Amount Due 1,950.00

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

RUBELITA H. AGGALUT, MD, MCH

DMO V/Provincial DOH Officer

B. Accounting Entry:
Account Title UACS Code

C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Supporting documents complete and amount claimed
proper

Signature Signature

Printed ARISTIDES CONCEPCION TAN, MD, MPH,

Printed Name
CHERRY PINK P. DIOCERA,CPA Name CESO III
Position Accountant III Position Director IV
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Bank Name & Account
No. : Number:
Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents

 Republic of the Philippines
Department of Health
REGIONAL OFFICE XII Fund Cluster : SAA No. 2023-
Cotabato City 02 - 000490
Date :
DISBURSEMENT VOUCHER DV No. :

Mode of MDS Check Commercial Check

Payment
_________________
Payee MARELYN Q. GONZALES TIN/Employee No.: ORS/BURS No.:
Address Amas, Kidapawan City
Particulars Responsibility Center MFO/PAP Amount

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

RUBELITA H. AGGALUT, MD, MCH

DMO V/Provincial DOH Officer

B. Accounting Entry:
Account Title UACS Code

C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Supporting documents complete and amount claimed
proper

Signature Signature

Printed ARISTIDES CONCEPCION TAN, MD, MPH,

Printed Name
CHERRY PINK P. DIOCERA,CPA Name CESO III

Position Accountant III Position Director IV

Date Date
E. Receipt of Payment JEV No.
Check/ ADA Bank Name & Account
No. : Number:
Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents

 Republic of the Philippines
Department of Health
REGIONAL OFFICE XII Fund Cluster : SAA No. 2023-
Cotabato City 02 - 000490
Date :
DISBURSEMENT VOUCHER DV No. :

Mode of MDS Check Commercial Check

Payment
_________________
Payee MARELYN Q. GONZALES TIN/Employee No.: ORS/BURS No.:
Address Amas, Kidapawan City
Particulars Responsibility Center MFO/PAP Amount

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

RUBELITA H. AGGALUT, MD, MCH

DMO V/Provincial DOH Officer

B. Accounting Entry:
Account Title UACS Code

C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Supporting documents complete and amount claimed
proper

Signature Signature

Printed ARISTIDES CONCEPCION TAN, MD, MPH,

Printed Name
CHERRY PINK P. DIOCERA,CPA Name CESO III

Position Accountant III Position Director IV

Date Date
E. Receipt of Payment JEV No.
Check/ ADA Bank Name & Account
No. : Number:
Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents

 Appendix 11

OBLIGATION REQUEST AND STATUS Serial No.

DEPARTMENT OF HEALTH RO12 Date : _________________________
Entity Name Fund Cluster: SAA NO. 2023-02-000490

Payee
Aleiah Jean L. Libatique, RPh
Office
Provincial DOH Office-Cotabato Province

Address
Amas, Kidapawan City
UACS Object
Responsibility Center Particulars MFO/PAP Amount
Code

13-001-03-00012- To obligate Travelling Expenses, as of 5020101000 1,950.00

224002000200000 May 2, to June 15, 2023, in the amount of…

Total 1,950.00

A. B.
Certified: Charges to appropriation/alloment are Certified: Allotment available and obligated
necessary, lawful and under my direct supervision;and for the purpose/adjustment necessary as
supporting documents valid, proper and legal indicated above

Signature : Signature :
Printed Name: RUBELITA H. AGGALUT, MD, MCH Printed Name: CRISTY LORRAINE E. DIAZON,CPA,MPA
Position : DMO V/Provincial DOH Officer Position : Administrative Officer V
Head, Requesting Office/Authorized Representative Head, Budget Division/Unit/Authorized Representative
Date : ___________________________________ Date : ____________________________

C. STATUS OF OBLIGATION
Reference Amount
Balance
ORS/JEV/Check/ Obligation Payable Payment Not Yet Due and
Date Particulars
ADA/TRA No. Due Demandable
(a) (b) (c) (a-b) (b-c)
 Appendix 11

OBLIGATION REQUEST AND STATUS Serial No.

DEPARTMENT OF HEALTH RO12 Date : _________________________
Entity Name Fund Cluster: PHM-Hospital System
Payee Marelyn Q. Gonzales
Office
Provincial DOH Office-Cotabato Province

Address
Amas, Kidapawan City
UACS Object
Responsibility Center Particulars MFO/PAP Amount
Code

13-001-03-00012-
To obligate Travelling Expenses as of Apr
25, -28, 2023, in the amount of…..
5020101000 1,950.00
224002000200000

Total 1,950.00

A. B.
Certified: Charges to appropriation/alloment are Certified: Allotment available and obligated
necessary, lawful and under my direct supervision;and for the purpose/adjustment necessary as
supporting documents valid, proper and legal indicated above

Signature : Signature :
Printed Name: RUBELITA H. AGGALUT, MD, MCH Printed Name: CRISTY LORRAINE E. DIAZON,CPA,MPA
Position : DMO V/Provincial DOH Officer Position : Administrative Officer V
Head, Requesting Office/Authorized Representative Head, Budget Division/Unit/Authorized Representative
Date : ___________________________________ Date : ____________________________

C. STATUS OF OBLIGATION
Reference Amount
Balance
ORS/JEV/Check/ Obligation Payable Payment Not Yet Due and
Date Particulars
ADA/TRA No. Due Demandable
(a) (b) (c) (a-b) (b-c)
 LIQUIDATION REPORT
Period Covered: __________________________

Entity Name : DEPARTMENT OF HEALTH - CENTER FOR

HEALTH DEVELOPMENT - SOCCSKSARGEN Region
Fund Cluster : _____________________________________________

PARTICULARS

To liquidate and refund the travelling expenses & PD incurred

during the conduct of Sabayang Patak Kontra Polio on
January 21, 2020 to February 2, 2020 in
Cotabato Province

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 the B Certified: Purpose of travel / C
above data cash advance duly accomplished

RUBELITA H. AGGALUT, MD, MCH AMEBELLA G. TARUC, MD, MPM

Signature over Printed Name Signature over Printed Name
Claimant Immediate Supervisor

Date: ______________________ Date: _____________________

 Appendix 44

Serial No.: ______________________

Date: _________________________

Responsibility Center Code:

__________________________

AMOUNT

#REF!

C Certified: Supporting documents

complete and proper

CHERRY PINK P. DIOCERA, CPA

Signature over Printed Name
Head, Accounting Division Unit

JEV No.: ___________________

Date: _____________________
0