Annex A

Republic of the Philippines

Department of Education
REGION VIII
SCHOOLS DIVISION OF MAASIN CITY
Maasin City

INVENTORY CUSTODIAN SLIP

Entity Name: MAASIN CITY DIVISION

Fund Cluster : MOOE ICS No : SPHV-2022-07-0054

Amount Inventory
Quantity Unit Description
Item No.
Unit Cost Total Cost

1 unit 31,150.00 31,150.00 ACER SPIN 5 LAPTOP SPECS:

MODEL: SP13-53N, TWO-IN-
ONE(TOUCH) S/N:
NXHVPSP00103003A1A6600,
INTEL CORE I5, 8265U BASE
SPEED 1.6GHZ, TURBO SPEED
3.9 GHZ, 6 MB CACHE, 16GB
ONBOARD DRR4 SYSTEM
MEMORY 13.3 DISPLAY W/ IPS,
FULL HD LED BACKLIT TFT LCD,
256GB SSD, SD CARD READER,
COLOR: CYAN BLUE W/
WIRELESS MOUSE, MOUSEPAD,
EXTERNAL 1TB HDD, HEADSET &
BAG, HEADSET: BRAND:
GOODNESS GS-233, BACK
MOUSE: COLOR: LIGHT BLUE,
EXTERNAL DRIVE: SP ARMOR
A30, SHOCK PROOF SCRATCH
RESISTANT , P/N: CO-2020-12-IT-
SO-00032

S/N: ZXP7JBB6G6U8QSVC
 Property No.: 2022-05-03-0276-17E

Date acquired: 7/8/2022

Received from: Received by:

GLOMERA S. LOLO IBARRA ROZ

Signature Over Printed Name Signature Over Printed Name
Supply Officer Principal I/IBARRA ES
Position/Office Position/Office
9/7/2022 9/7/2022
Date Date

EGD-OSDS/SUU-SD/FO-06
 Annex A.3

No : SPHV-2022-07-0054

Estimated
Useful Life

5 years
A ROZ
Printed Name
BARRA ES
/Office
022
te
 Annex A

Republic of the Philippines

Department of Education
REGION VIII
SCHOOLS DIVISION OF MAASIN CITY
Maasin City

INVENTORY CUSTODIAN SLIP

Entity Name: MAASIN CITY DIVISION

Fund Cluster : MOOE ICS No : SPLV-2022-07-0054

Amount Inventory
Quantity Unit Description
Item No.
Unit Cost Total Cost

1 unit 4,980.00 4,980.00 UPS VA 2000 S/N: 2009890

Date acquired: 7/8/2022

Received from: Received by:

GLOMERA S. LOLO IBARRA ROZ

 Signature Over Printed Name Signature Over Printed Name
Supply Officer - Des. Principal I/IBARRA ES
Position/Office Position/Office
_____________
Date Date

EGD-OSDS/SUU-SD/FO-06
 Annex A.3

No : SPLV-2022-07-0054

Estimated
Useful Life

5 years

A ROZ
Printed Name
BARRA ES
/Office
______
te
Entity Name: _______DEPED-MAASIN CITY DIVISION_______
Semi-Expendable Property:________ICT EQUIPMENT_____________

Reference
Date
ICS/RRSP No. Semi-expendable Property No.

11/20/2022 SPHV-2022-07-0054 2022-05-03-0276-17E

 REGISTRY SEMI-EXPENDABLE PROPERTY I

________

Issue
Estimated
Item Description
Useful Life Qty. Office/Officer

Acer Spin 5 Laptop

5 1 Ibarra ES/Ibarra Roz
SN:1234567890
BLE PROPERTY ISSUED

Returned Re-issued Disposed

Qty. Office/Officer Qty. Office/Officer Qty.
 Annex A. 4

Fund Cluster: ________CO_________

Sheet No. : ______001___________

Balance
Amount Remarks
Qty.

31,150.00 In good condition

 Republic of the Philippines

Department of Education
REGION VIII
SCHOOLS DIVISION OF MAASIN CITY
Maasin City

INVENTORY TRANSFER REPORT

Entity Name:_______DEPED-MAASIN CITY DIVISION_________

From Accountable Officer/Agency/Fund Cluster: _Ibarra Roz__

To Accountable Officer/Agency/Fund Cluster: __Joe Lopez____

Transfer Type: (check only one)
Donation Relocate
Reassignment Others (Specify) _To transfer accountabi

Date Acquired Item No. ICS No./Date Description

06/16/2023 SPHV-2022-07-0054 Acer Spin 5

Reason/s for Transfer:

To transfer accountability

Released/Issued
Approved by: by:
Signature:
Printed Name:
Designation:
Date: 06/16/2023 06/16/2023
 Annex A.5

ation
CITY

PORT

Fund Cluster: __CO________

ITR No. : _2023-06-002__

Date: _06/16/2023__

pecify) _To transfer accountability_

Condition of
Amount
Inventory

31,150.00 Serviceable

Received by:
JOE LOPEZ
T-III
06/16/2023
 SEMI-EXPENDABLE PR

Entity Name: _______DEPED-MAASIN CITY DIVISION_______

Semi-expendable Property : ICT EQUIPMENT
Description : LAPTOP ACER SPIN, BLUE,
Receipt
Date Reference
Qty. Unit Cost Total Cost

11/02/2022 JEV NO. 22134 5 ₱31,150.00 ₱155,750.00

3/11/2022 ICS#: SPHV-2022-11-0001

3/11/2022 ICS#: SPHV-2022-11-0002

3/11/2022 ICS#: SPHV-2022-11-0003
3/11/2022 ICS#: SPHV-2022-11-0004
3/11/2022 ICS#: SPHV-2022-11-0005
EXPENDABLE PROPERTY CARD

Fund Cluster: DEPED CO

Semi-expendable Property Number:____2022-05-03_____

Issue Balance
Amount
Item No. Qty. Office/Officer Qty.

IBARRA ES/Ibarra
1 4
Roz
1 MCS/ Juan Cruz 3
1 TIS/ Pedro Dantes 2
1 AIS/ Lina Kikay 1

1 DNHS/ Joel Cruz 0

 Annex A. 1

mber:____2022-05-03_____________

Remarks
 STOCK CARD

Entity Name: _______DEPED-MAASIN CITY DIVISION_______

Item : PRINTER INK
Description : EPSON 003, BLACK
Unit of Measurement : PIECE
Receipt Issue
Date Reference
Qty. Qty.
2/02/2015 PO NO. 2345690 15

2/03/2015 RIS#: 0000-00-000 2

2/03/2015 RIS#: 0000-00-000 10

2/03/2015 RIS#: 0000-00-000 3

 Appendix 58

STOCK CARD

ON_______ Fund Cluster: MOOE

Stock No. : 2015-001
Re-order Point :

Issue Balance
No. of Days to Consume
Office Qty.
15

CASH 13

ACCOUNTING 3

HR 0
 Republic of the Philippines

Department of Education
REGION VIII
SCHOOLS DIVISION OF MAASIN CITY
Maasin City

RECEIPT OF RETURNED SEMI-EXPENDABLE PROPERTY

Entity Name: DEPED-MAASIN CITY DIVISION

This is to acknowledge receipt of the returned Semi-expendable Property

Item Description Quantity ICS No. End-user

Acer Spin 5 1 SPHV-2022-07-0054 Ibarra Roz
Returned by: Received by:

Ibarra Roz GLOMERA S. LOLO

End User Head, Property and/or Supply Div

06/16/2023 06/16/2023
Date Date
 Annex A.6

on

ROPERTY

Date: 06/16/2023

RRSP No.: 2023-06-001

Remarks
In good condition
 GLOMERA S. LOLO
perty and/or Supply Division/Unit

06/16/2023
Date
 PROPERTY CARD

Entity Name : ___________________________________

Property, Plant and Equipment :

Description :

Reference/ Receipt Issue/Transfer/ Disposal

Date
PAR No. Qty. Qty. Office/Officer
169
 Appendix 69

PROPERTY CARD

Fund Cluster: ______________________

Property Number:_____________________

Transfer/ Disposal Balance

Amount Remarks
Office/Officer Qty.
 PROPERTY ACKNOWLEDGMENT RECEIPT

Entity Name : _________________________________

Fund Cluster: _____________________________________ PAR No.: _________________

Property Date
Quantity Unit Description
Number Acquired
Received by: Issued by:
_________________________________________ __________________________________________
Signatue over Printed Name of Supply and/or
Signatue over Printed Name of End User
Property Custodian

__________________________________ _______________________________
Position/Office Position/Office

_________________________ _________________________
Date Date
 Appendix 71

CEIPT

R No.: _________________

Amount
__________________________
rinted Name of Supply and/or
perty Custodian

____________________
osition/Office

__________________
Date
 Appendix 76

PROPERTY TRANSFER REPORT

Entity Name : _______________________________ Fund Cluster : _____________

From Accountable Officer/Agency/Fund Cluster : __________________________ PTR No. : ______________

To Accountable Officer/Agency/Fund Cluster : ____________________________ Date : _________________

Transfer Type: (check only one)

Donation Relocate
Reassignment Others (Specify) _________________

Date Acquired Property No. Description Amount

Reason for Transfer:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
 ___________________________________________________________________________

Approved by: Released/Issued by: Received by:

Signature :
Printed Name :
Designation :
Date :
 Appendix 76

Cluster : _____________

R No. : ______________
e : _________________

Condition of
PPE

_____________
_____________
_____________
_____________
_____________
 REPORT ON THE PHYSICAL COUNT OF SEMI-EXPEN

(Type of Semi-expendable Property)

As at ________________________________

Fund Cluster : ________________________________

For which (Name of Accountable Officer), ( Official Designation), (Entity Name) is accountable, having assumed such accounta

SEMI-
UNIT OF
ARTICLE DESCRIPTION EXPENDABLE UNIT VALUE
MEASURE
PROPERTY NO.

0.00

Certified Correct by: Approved by:

GLOMERA S. LOLO JOSILYN S. SOLANA, C

Signature over Printed Name of Signature over Printed Name of Head
Inventory Committee Chair and or Authorized Representa
Members
 Annex A.8

COUNT OF SEMI-EXPENDABLE PROPERTY

f Semi-expendable Property)
___________________________

ntable, having assumed such accountability on _(Date of Assumption).

BALANCE PER ON HAND PER

SHORTAGE/OVERAGE
CARD COUNT REMAKS
(QUANTITY) (QUANTITY) Quantity Value

Verified by:

JOSILYN S. SOLANA, CESO V _______________________________

ignature over Printed Name of Head of Agency/Entity Signature over Printed Name of COA
or Authorized Representative Representative
 REPORT ON THE PHYSICAL COUNT OF PROPERTY, PLA
BUILDINGS
(Type of Property, Plant and Equipment)
As at ________________________________

Fund Cluster : ________________________________

For which JOSILYN S. SOLANA, Schools Division Superintendent, Division of Maasin City is accountable, having assumed su

PROPERTY UNIT OF
ARTICLE DESCRIPTION UNIT VALUE
NUMBER MEASURE

Division Office Building, 1 Storey, 2 Units 2009-04-01-001 1,926,864.11

Division Learning Center, 1 Storey, 1 Unit 2011-04-01-002 882,833.00
Maasin City Division Office 2014-04-01-003 9,815,682.86

12,625,379.97

Certified Correct by: Approved by:

GLOMERA S. LOLO JOSILYN S. SOLANA, C

Signature over Printed Name of Signature over Printed Name of Head
Inventory Committee Chair and or Authorized Representa
Members
 Appendix 73

UNT OF PROPERTY, PLANT AND EQUIPMENT

BUILDINGS
Property, Plant and Equipment)
___________________________

City is accountable, having assumed such accountability on _(Date of Assumption).

QUANTITY QUANTITY
SHORTAGE/OVERAGE
per per REMAKS
PROPERTY CARD PHYSICAL COUNT Quantity Value
1 1 Needs Major Repair
1 1 In Good Condition
1 1 In Good Condition

Verified by:

JOSILYN S. SOLANA, CESO V _______________________________

ignature over Printed Name of Head of Agency/Entity Signature over Printed Name of COA
or Authorized Representative Representative
 Annex A

REPORT OF LOST, STOLEN, DAMAGED OR DESTROYED SEMI-EXPENDABLE PROPERTY

Entity Name : __________________________ Fund Cluster: ______________

Department/Office : ____________________________________ RLSDDP No. : ______________

Accountable Officer : ___________________________________ RLSDDP Date : _____________
Designation : __________________________________________ PAR No. : _________________
Police Notified : Yes Police Station : ________________ PAR Date : ________________
Date : ________________________
No

Status of semi-expendable Property : (check applicable box)

Lost Damaged
Stolen Destroyed

Property No. Description Acquisition Cost

Circumstances:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

I hereby certify that the item/s and circumstances

stated above are true and correct. Noted by:

__________________________________________ __________________________________
Signature over Printed Name of the Accountable Signature over Printed Name of the Immediate Supervisor
Officer
________________ ________________
Date Date

Government Issued ID : __________________

ID No. : _____________________________
Date Issued : _________________________

SUBSCRIBED AND SWORN to before me this ______day of _____________, affiant exhibiting the above
government issued identification card.

Doc. No. _________

Page No. _________ Notary Public
Book No. _________
Series of _________
 Annex A.9

ROYED SEMI-EXPENDABLE PROPERTY

Fund Cluster: ______________

RLSDDP No. : ______________

RLSDDP Date : _____________
PAR No. : _________________
PAR Date : ________________

Acquisition Cost

___________________________________
___________________________________
___________________________________
___________________________________

_________________________________
over Printed Name of the Immediate Supervisor
________________
Date
____________, affiant exhibiting the above
 INVENTORY AND INSPECTION REPORT OF UNS
As at _______________

Entity Name: DIVISION OF MAASIN CITY

GENIS S. MURALLOS ______________________________
(Name of Accountable Officer) (Designation)

INVENTORY

Semi-
Date expendable Unit Total Accumulated
Particulars/ Articles Qty
Acquired Property Cost Cost Depreciation
No.

(1) (2) (3) (4) (5) (6) (7)

Lenovo Laptop S/N: LR-
1 01/21/2013 32G6A 1 29,457.79 29,457.79

2 Asus Laptop S/N:

PG9RY9QWGT-2JHX9
3 01/15/2015 Acer Laptop S/N:
51000033676 MARICHU 30,776.72 30,776.72

4 Lenovo Laptop S/N: LR-

LXXEE
5 Lenovo Laptop S/N: LR-
YDFZZ
6
7
AcerTravelMate Laptop S/N:
8 NXV7CSP01024806FC87600

9
10 HP Laptop S/N: CNU829319Y

I HEREBY request inspection and disposition, pursuant to Section 79 of PD 1445, of the property enumerate

Requested by: Approved by:

(Signature over Printed Name of Accountable (Signature over Printed Nam
Officer) Authorized Official)

(Designation of Accountable Officer) (Designation of Authorized O

 Annex A.

ON REPORT OF UNSERVICEABLE SEMI-EXPENDABLE PROPERTY

As at _________________________________

Fund Cluster : ___________________

_______________ ______________________________
nation) (Station)

INSPECTION and DISPOSAL

DISPOSAL
Accumulated
Carrying Appraised
Impairment Remarks
Amount Others Value
Losses Sale Transfer Destruction Total
(Specify)

(8) (9) (10) (11) (12) (13) (14) (15) (16)

Not Functional

I CERTIFY that I have inspected each I CERTIFY that I have

45, of the property enumerated above. and every article enumerated in this witnessed the disposition of t
report, and that the disposition made articles enumerated on this
thereof was, in my judgment, the best for report this ____day of
the public interest. _____________, _____.
 (Signature over Printed Name of (Signature over Printed Name of (Signature over Printed Nam
Authorized Official) Inspection Officer) Witness)

(Designation of Authorized Official)

 Annex A. 10

uster : _____________________

OSAL

RECORD OF SALES

OR No. Amount

(17) (18)

I CERTIFY that I have

witnessed the disposition of the
articles enumerated on this
report this ____day of
_____________, _____.
(Signature over Printed Name of
Witness)
 Appendix 65

WASTE MATERIALS REPORT

Entity Name : ______________________________ Fund Cluster : _____________________

Place of Storage : ___________________________________________ Date : ________________________________

ITEMS FOR DISPOSAL

Record of Sales
Item Quantity Unit Description Official Receipt
No. Date
1
2
3
4
5
6
7
8
9
10
TOTAL
Certified Correct : Disposal Approved :
__________________________________
Signature over Printed Name of Supply Signature over Printed Name of Head of
and/or Property Custodian Agency/Entity or his/her Authorized
Representative

CERTIFICATE OF INSPECTION

I hereby certify that the property enumerated above was disposed of as follows:

Item ________ Destroyed

Item ________ Sold at private sale
Item ________ Sold at public auction
Item ________ Transferred without cost to __(Name of the Agency/Entity)__

Certified Correct: Witness to Disposal:

Signature over Printed Name of Signature over Printed Name of

Inspection Officer Witness
 Appendix 65

_________________

___________________

ord of Sales
icial Receipt
Amount

_____________________
Printed Name of Head of
y or his/her Authorized
presentative
 INVENTORY AND INSPECTION REPORT OF UNSER
As at ______________________________

Entity Name: _______________________________________

______________________________ ______________________________
(Name of Accountable Officer) (Designation)

INVENTORY

Accumulated
Date Particulars/ Property Unit Total Accumulated Carrying
Qty Impairment
Acquired Articles No. Cost Cost Depreciation Amount
Losses

(1) (2) (3) (4) (5) (6) (7) (8) (9)

I HEREBY request inspection and disposition, pursuant to Section 79 of PD 1445, of the property enumerated above.

Requested by: Approved by:

(Signature over Printed Name of (Signature over Printed Name of

Accountable Officer) Authorized Official)

(Designation of Accountable Officer) (Designation of Authorized Official)

 Annex A. 10

REPORT OF UNSERVICEABLE PROPERTY

________________________

Fund Cluster : _____________________

______________________________
(Station)

INSPECTION and DISPOSAL

DISPOSAL RECORD OF SALES

Appraised
Remarks
Others Value
Sale Transfer Destruction Total OR No. Amount
(Specify)

(10) (11) (12) (13) (14) (15) (16) (17) (18)

I CERTIFY that I have inspected each I CERTIFY that I have

rty enumerated above. and every article enumerated in this witnessed the disposition of the
report, and that the disposition made articles enumerated on this
thereof was, in my judgment, the best for report this ____day of
the public interest. _____________, _____.

(Signature over Printed Name of (Signature over Printed Name of

Inspection Officer) Witness)