Level: __________________
We acknowledge receipt of cash shown opposite of our name as full compensation for services rendered during the National Learning Camp for the period covered.
LAST NAME, FIRST
NO.
EMPLOYEE NUMBER
ACCOUNT NUMBER NAME, MIDDLE SCHOOL POSITION PERIOD COVERED TO PAY NET AMOUNT No. SIGNATURE
NAME
MELQUIADEZ S.
1 MANALO, JR. 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 14
15 15
16 16
17 17
18 18
19 19
20 20
21 21
22 22
23 23
24 24
25 25
26 26
27 27
28 28
29 29
30 30
31 31
32 32
33 33
34 34
35 35
36 36
37 37
38 38
39 39
40 40
41 41
42 42
43 43
44 44
45 45
46 46
47 47
48 48
49 49
50 50
51 51
52 52
53 53
54 54
55 55
56 56
57 57
58 58
59 59
60 60
61 61
62 62
63 63
64 64
65 65
66 66
67 67
68 68
69 69
70 70
71 71
72 72
73 73
74 74
75 75
76 76
77 77
- - -
A. CERTIFIED: Services duly rendered as stated: C. APPROVED PAYMENT:
Pesos Only***
JOVITA G. DIZON RONNIE S. MALLARI, PhD., CESO V
Administrative Officer V Schools Division Superintendent
Authorized Officer Office of the Schools Division Superintendent
B. CERTIFIED: Supporting documents complete and proper, and cash D. CERTIFIED: Each employee ALOBS No.________
available in the amount of P ________ appears above has been paid the amDate:_________
indicated opposite on his/her name. JEV No.__________
Date: _________
JEROME C. VALETE, CPA ESTRELLA C. GUTIERREZ
OIC- Accountant III Administrative Officer IV
Head, Accounting Unit Head, Cash Unit
C
Level: _____________________
This is to certify that the following teachers actually rendered services during the National Learning Camp.
LAST NAME, FIRST NAME,
NO. EMPLOYEE NUMBER ACCOUNT NUMBER SCHOOL POSITION PERIOD COVERED TO PAY NET AMOUNT No. REMARKS
MIDDLE NAME
1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 14
15 15
16 16
17 17
18 18
19 19
20 20
21 21
22 22
23 23
24 24
25 25
26 26
27 27
28 28
29 29
30 30
31 31
32 32
33 33
34 34
35 35
36 36
37 37
38 38
39 39
40 40
41 41
42 42
43 43
44 44
TOTAL 0 0
Certified Correct: Noted:
JOVITA G. DIZON RONNIE S. MALLARI, PhD., CESO V
Administrative Officer - V Schools Division Superintendent
HEADING AY SCHOOL DETAILS
SIGNATURE
NO. NAME July 24, 2023 July 25, 2023 July 26, 2023 July 27, 2023 July 28, 2023
10
11
12
13
14
15
Prepared By: Certified Correct By:
Faculty President or Admin Officer II School Head
Republic of the Philippines Republic of the Philippines
Department of Education Department of Education
REGION III REGION III
SCHOOLS DIVISION OF TARLAC PROVINCE SCHOOLS DIVISION OF TARLAC PROVINCE
LA PAZ SOUTH DISTRICT LA PAZ SOUTH DISTRICT
SAN ISIDRO CENTRAL ELEMENTARY SCHOOL SAN ISIDRO CENTRAL ELEMENTARY SCHOOL
SAN ISIDRO, LA PAZ, TARLAC SAN ISIDRO, LA PAZ, TARLAC
CERTIFICATE OF EXPENSES NOT REQUIRING RECEIPTS CERTIFICATE OF EXPENSES NOT REQUIRING RECEIPTS
Pursuant to COA Circular No. 2017-001 dated June 19, 2017 Pursuant to COA Circular No. 2017-001 dated June 19, 2017
Name: Employee No. Name: Employee No.
Office Office
Division Division
Particulars Amount (₱) Particulars Amount (₱)
To payment of meals expense To payment of meals expense
incurred during NLC activities…. incurred during NLC activities….
250.00 250.00
TOTAL 250.00 TOTAL 250.00
Purpose: Payment of Meals Expense during NATIONAL LEARNING CAMP Purpose: Payment of Meals Expense during NATIONAL LEARNING CAMP
ACTIVITIES ACTIVITIES
I hereby certify that the above expenses are incurred as they are necessary for the above cited I hereby certify that the above expenses are incurred as they are necessary for the above cited
purpose, that above goods and services were acquired from parties not issuing reciepts. And that I purpose, that above goods and services were acquired from parties not issuing reciepts. And
am fully aware that witful falsification of statements is punishable by law. that I am fully aware that witful falsification of statements is punishable by law.
Certified correct: Noted by: Certified correct: Noted by:
Signature Signature
Printed Name Printed Name
Employee Immediate Supervisor Employee Immediate Supervisor
Date Date Date Date
