APPENDIX A

Date: February 4, 2023

ITINERARY OF TRAVEL
Name: MA. CRISTINA B. DISTOR Position: Teacher III
Official Station: SAN ANTONIO NATIONAL HIGH SCHOOL Monthly Salary: P 31,949.00
Purpose of travel: To attend District Roll-out on Contingency Planning on Multiple Hazards (Day 2).

Date Place to Visit Departure Arrival Means of Fare Per TOTAL

Transpotation Diem
February 4, 2023 Station-District Office, Cuartero 7:00AM 8:00AM Motorcycle 200.00 200.00
District Office, Cuartero-Station 5:00PM 6:00PM Motorcycle 200.00 200.00
400.00
TOTAL 400.00
1) I HEREBY CERTIFFY that I have reviewed the foregoing itinerary. Prepared by:
(2) the trtavel is necessary to service. (3) the period covered is reasonable
(4) the expense claimed are proper.
MA. CRISTINA B. DISTOR
Teacher III
Approved by:
LOURDES V. PALIGUMBA
Supervisor/Immediate Supervisor LOURDES V. PALIGUMBA
Principal I

APPENDIX B
LOURDES V. PALIGUMBA Date: February 4, 2023
Principal I Station: San Antonio NHS

I hereby certicy that I have completed the travel authhoorized in the iterinary of travel No. _________
Dated________________________________ under the conditions indicated below.
X Strictly with accordance with the prepared iterinary
Cut short eexplained below, excess payment in the amount of
was refunded under OR No. dated.
Extended as explained below. Additional iterinary was submitted:
Other deviation was explained below.

Attach supporting documents: Certiificate of Appearance, Travel Order.

On evidence and information of which I have knowledge, the travel undertaken.
Resspectfully Submitted:

MA. CRISTINA B. DISTOR

Teacher III

LOURDES V. PALIGUMBA
Principal I
 ANNEX A

Department of Education
Region VI - Western Visayas
Schools Division of Capiz
Roxas City

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS

Pursuant to COA Circular No. 2017-001- dated June 19, 2017
Name of Employee MA. CRISTINA B. DISTOR Employee No. 42007612
Office SAN ANTONIO NATIONAL HIGH SCHOOL
Division CAPIZ
Particulars Amount ((₱)
Travel (Transportation) February 4, 2023

Station-District Office, Cuartero 200.00

District Office, Cuartero-Station 200.00

TOTAL 400.00
Purpose

To attend District Roll-out on Contingency Planning on Multiple Hazards (Day 2).

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 receipts. And that I am fully aware that wilful falsification of statements is
punishable by law.
Certified Correct: Noted By:
Signature:
Printed Name: MA. CRISTINA B. DISTOR LOURDES V. PALIGUMBA
Employee Immediate Supervisor
Date February 4, 2023 Date
 s
Roxas city Term.-Kapis Mansion R.C.

Per Diem

Kapis Mansion R.C. - Roxas City Term

p Roxas city Term.-Capiz Division Office, Banica, R.C.

Per Diem

Capiz Division Office, Banica, R.C. - Roxas City Term

Station - Capelco, Cuartero, Capiz

Capelco, Cuartero, Capiz - Station

 APPENDIX A
Date: July 10, 2023
ITINERARY OF TRAVEL
Name: ANALEA E. FUENTES Position: HT-I
Official Station: SAN ANTONIO NATIONAL HIGH SCHOOL Monthly Salary: P 34,535.00
Purpose of travel: To attend Local School Board Meeting about Anniversary Plan/Preparations.

Date Place to Visit Departure Arrival Means of Fare Per TOTAL

Transpotation Diem
July 10, 2023 Station-Office of the Municipal Mayor, Cuartero 7:00 AM 8:15 AM Motorcycle 200.00 200.00
Office of the Municipal Mayor, Cuartero-Station 1:00 PM 2:15 PM Motorcycle 200.00 200.00
400.00
TOTAL 400.00
1) I HEREBY CERTIFFY that I have reviewed the foregoing itinerary. Prepared by:
(2) the trtavel is necessary to service. (3) the period covered is reasonable
(4) the expense claimed are proper.
ANALEA E. FUENTES
Teacher III
Approved by:
LOURDES V. PALIGUMBA
Supervisor/Immediate Supervisor LOURDES V. PALIGUMBA
Principal I

APPENDIX B
LOURDES V. PALIGUMBA Date: July 10, 2023
Principal I Station: San Antonio NHS

I hereby certicy that I have completed the travel authhoorized in the iterinary of travel No. _________
Dated________________________________ under the conditions indicated below.
X Strictly with accordance with the prepared iterinary
Cut short eexplained below, excess payment in the amount of
was refunded under OR No. dated.
Extended as explained below. Additional iterinary was submitted:
Other deviation was explained below.

Attach supporting documents: Certiificate of Appearance, Travel Order.

On evidence and information of which I have knowledge, the travel undertaken.
Resspectfully Submitted:

ANALEA E. FUENTES
Teacher III

LOURDES V. PALIGUMBA
Principal I
 ANNEX A

Department of Education
Region VI - Western Visayas
Schools Division of Capiz
Roxas City

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS

Pursuant to COA Circular No. 2017-001- dated June 19, 2017
Name of Employee ANALEA E. FUENTES Employee No. 06350764
Office SAN ANTONIO NATIONAL HIGH SCHOOL
Division CAPIZ
Particulars Amount ((₱)
Travel (Transportation) July 10, 2023

Station-Office of the Municipal Mayor, Cuartero 200.00

Office of the Municipal Mayor, Cuartero-Station 200.00

TOTAL 400.00
Purpose

To attend Local School Board Meeting about Anniversary Plan/Preparations.

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 receipts. And that I am fully aware that wilful falsification of statements is
punishable by law.
Certified Correct: Noted By:
Signature:
Printed Name: ANALEA E. FUENTES LOURDES V. PALIGUMBA
Employee Immediate Supervisor
Date July 10, 2023 Date
 s
Roxas city Term.-Kapis Mansion R.C.

Per Diem

Kapis Mansion R.C. - Roxas City Term

p Roxas city Term.-Capiz Division Office, Banica, R.C.

Per Diem

Capiz Division Office, Banica, R.C. - Roxas City Term

Station - Capelco, Cuartero, Capiz

Capelco, Cuartero, Capiz - Station

 APPENDIX A
Date: July 6, 2023
ITINERARY OF TRAVEL
Name: ANALEA E. FUENTES Position: HT-I
Official Station: SAN ANTONIO NATIONAL HIGH SCHOOL Monthly Salary: P 34,535.00
Purpose of travel: To attend Meeting about Anniversary Plan/Preparations.

Date Place to Visit Departure Arrival Means of Fare Per TOTAL

Transpotation Diem
July 6, 2023 Station-Office of the Municipal Mayor, Cuartero 7:00 AM 8:15 AM Motorcycle 200.00 200.00
Office of the Municipal Mayor, Cuartero-Station 1:00 PM 2:15 PM Motorcycle 200.00 200.00
400.00
TOTAL 400.00
1) I HEREBY CERTIFFY that I have reviewed the foregoing itinerary. Prepared by:
(2) the trtavel is necessary to service. (3) the period covered is reasonable
(4) the expense claimed are proper.
ANALEA E. FUENTES
Teacher III
Approved by:
LOURDES V. PALIGUMBA
Supervisor/Immediate Supervisor LOURDES V. PALIGUMBA
Principal I

APPENDIX B
LOURDES V. PALIGUMBA Date: July 6, 2023
Principal I Station: San Antonio NHS

I hereby certicy that I have completed the travel authhoorized in the iterinary of travel No. _________
Dated________________________________ under the conditions indicated below.
X Strictly with accordance with the prepared iterinary
Cut short eexplained below, excess payment in the amount of
was refunded under OR No. dated.
Extended as explained below. Additional iterinary was submitted:
Other deviation was explained below.

Attach supporting documents: Certiificate of Appearance, Travel Order.

On evidence and information of which I have knowledge, the travel undertaken.
Resspectfully Submitted:

ANALEA E. FUENTES
Teacher III

LOURDES V. PALIGUMBA
Principal I
 ANNEX A

Department of Education
Region VI - Western Visayas
Schools Division of Capiz
Roxas City

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS

Pursuant to COA Circular No. 2017-001- dated June 19, 2017
Name of Employee ANALEA E. FUENTES Employee No. 06350764
Office SAN ANTONIO NATIONAL HIGH SCHOOL
Division CAPIZ
Particulars Amount ((₱)
Travel (Transportation) July 6, 2023

Station-Office of the Municipal Mayor, Cuartero 200.00

Office of the Municipal Mayor, Cuartero-Station 200.00

TOTAL 400.00
Purpose

To attend Meeting about Anniversary Plan/Preparations.

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 receipts. And that I am fully aware that wilful falsification of statements is
punishable by law.
Certified Correct: Noted By:
Signature:
Printed Name: ANALEA E. FUENTES LOURDES V. PALIGUMBA
Employee Immediate Supervisor
Date July 6, 2023 Date
 s
Roxas city Term.-Kapis Mansion R.C.

Per Diem

Kapis Mansion R.C. - Roxas City Term

p Roxas city Term.-Capiz Division Office, Banica, R.C.

Per Diem

Capiz Division Office, Banica, R.C. - Roxas City Term

Station - Capelco, Cuartero, Capiz

Capelco, Cuartero, Capiz - Station

 APPENDIX A
Date: July 3, 2023
ITINERARY OF TRAVEL
Name: ANALEA E. FUENTES Position: HT I
Official Station: SAN ANTONIO NATIONAL HIGH SCHOOL Monthly Salary: P 34,535.00
Purpose of travel: To attend 8th Division Convergence of Education Leaders for Elementary, Secondary and Integrated School Heads.

Date Place to Visit Departure Arrival Means of Fare Per TOTAL

Transpotation Diem
July 3, 2023 Station-Maayon L3 Terminal 6:00 AM 6:15 AM Motorcycle 100.00 100.00
Maayon L3 Terminal-Roxas Terminal 6:15 AM 7:15 AM L300 Van 75.00 75.00
Roxas City Term.-Circulo, Pueblo de Panay, R.C. 7:15 AM 7:30AM Tricycle 40.00 40.00
Circulo, Pueblo de Panay, R.C.-Roxas City Term 5:00 PM 5:15 PM Tricycle 40.00 40.00
Roxas City Term. -Maayon L300 Terminal 5:15 PM 6:15 PM L300 Van 75.00 75.00
Maayon L3 Terminal-Station 6:15 PM 6:45 PM Motorcycle 100.00 100.00
430.00
TOTAL 430.00
1) I HEREBY CERTIFFY that I have reviewed the foregoing itinerary. Prepared by:
(2) the trtavel is necessary to service. (3) the period covered is reasonable
(4) the expense claimed are proper.
ANALEA E. FUENTES
HT I
Approved by:
LOURDES V. PALIGUMBA
Supervisor/Immediate Supervisor LOURDES V. PALIGUMBA
Principal I

APPENDIX B
LOURDES V. PALIGUMBA Date: July 3, 2023
Principal I Station: San Antonio NHS

I hereby certicy that I have completed the travel authhoorized in the iterinary of travel No. _________
Dated________________________________ under the conditions indicated below.
X Strictly with accordance with the prepared iterinary
Cut short eexplained below, excess payment in the amount of
was refunded under OR No. dated.
Extended as explained below. Additional iterinary was submitted:
Other deviation was explained below.

Attach supporting documents: Certiificate of Appearance, Travel Order.

On evidence and information of which I have knowledge, the travel undertaken.
Resspectfully Submitted:

ANALEA E. FUENTES
HT I

LOURDES V. PALIGUMBA
Principal I
 ANNEX A

Department of Education
Region VI - Western Visayas
Schools Division of Capiz
Roxas City

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS

Pursuant to COA Circular No. 2017-001- dated June 19, 2017
Name of Employee ANALEA E. FUENTES Employee No. 06350764
Office SAN ANTONIO NATIONAL HIGH SCHOOL
Division CAPIZ
Particulars Amount ((₱)
Travel (Transportation) July 3, 2023

Station-Maayon L3 Terminal 100.00

Maayon L3 Terminal-Roxas Terminal 75.00
Roxas City Term.-Circulo, Pueblo de Panay, R.C. 40.00

Circulo, Pueblo de Panay, R.C.-Roxas City Term 40.00

Roxas City Term. -Maayon L300 Terminal 75.00
Maayon L3 Terminal-Station 100.00

TOTAL 430.00
Purpose

To attend 8th Division Convergence of Education Leaders for Elementary, Secondary and Integrated School Heads.

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 receipts. And that I am fully aware that wilful falsification of statements is
punishable by law.
Certified Correct: Noted By:
Signature:
Printed Name: ANALEA E. FUENTES LOURDES V. PALIGUMBA
Employee Immediate Supervisor
Date July 3, 2023 Date
 s
Roxas city Term.-Kapis Mansion R.C.

Per Diem

Kapis Mansion R.C. - Roxas City Term

p Roxas city Term.-Capiz Division Office, Banica, R.C.

Per Diem

Capiz Division Office, Banica, R.C. - Roxas City Term

Station - Capelco, Cuartero, Capiz

Capelco, Cuartero, Capiz - Station

 APPENDIX A
Date: July 19, 2023
ITINERARY OF TRAVEL
Name: ALDEN M. DACLES Position: Teacher I
Official Station: SAN ANTONIO NATIONAL HIGH SCHOOL Monthly Salary: P 27,000.00
Purpose of travel: `

Date Place to Visit Departure Arrival Means of Fare Per TOTAL

Transpotation Diem
July 19, 2023 Station-Cuartero NHS 11:30 AM 12:30: PM Motorcycle 200.00 200.00
Cuartero NHS-Station 5:00 PM 6:45 PM Motorcycle 200.00 200.00
400.00
TOTAL 400.00
1) I HEREBY CERTIFFY that I have reviewed the foregoing itinerary. Prepared by:
(2) the trtavel is necessary to service. (3) the period covered is reasonable
(4) the expense claimed are proper.
ALDEN M. DACLES
Teacher I
Approved by:
LOURDES V. PALIGUMBA
Supervisor/Immediate Supervisor LOURDES V. PALIGUMBA
Principal I

APPENDIX B
LOURDES V. PALIGUMBA Date: July 19, 2023
Principal I Station: San Antonio NHS

I hereby certicy that I have completed the travel authhoorized in the iterinary of travel No. _________
Dated________________________________ under the conditions indicated below.
X Strictly with accordance with the prepared iterinary
Cut short eexplained below, excess payment in the amount of
was refunded under OR No. dated.
Extended as explained below. Additional iterinary was submitted:
Other deviation was explained below.

Attach supporting documents: Certiificate of Appearance, Travel Order.

On evidence and information of which I have knowledge, the travel undertaken.
Resspectfully Submitted:

ALDEN M. DACLES
Teacher I

LOURDES V. PALIGUMBA
Principal I
 ANNEX A

Department of Education
Region VI - Western Visayas
Schools Division of Capiz
Roxas City

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS

Pursuant to COA Circular No. 2017-001- dated June 19, 2017
Name of Employee ALDEN M. DACLES Employee No.
Office SAN ANTONIO NATIONAL HIGH SCHOOL
Division CAPIZ
Particulars Amount ((₱)
Travel (Transportation) July 19, 2023

Station-Cuartero NHS 200.00

Cuartero NHS-Station 200.00

TOTAL 400.00
Purpose

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 receipts. And that I am fully aware that wilful falsification of statements is
punishable by law.
Certified Correct: Noted By:
Signature:
Printed Name: ALDEN M. DACLES LOURDES V. PALIGUMBA
Employee Immediate Supervisor
Date July 19, 2023 Date
 s
Roxas city Term.-Kapis Mansion R.C.

Per Diem

Kapis Mansion R.C. - Roxas City Term

p Roxas city Term.-Capiz Division Office, Banica, R.C.

Per Diem

Capiz Division Office, Banica, R.C. - Roxas City Term

Station - Capelco, Cuartero, Capiz

Capelco, Cuartero, Capiz - Station

 APPENDIX A
Date: July 19, 2023
ITINERARY OF TRAVEL
Name: ALDEN M. DACLES Position: Teacher I
Official Station: SAN ANTONIO NATIONAL HIGH SCHOOL Monthly Salary: P 27,000.00
Purpose of travel: `

Date Place to Visit Departure Arrival Means of Fare Per TOTAL

Transpotation Diem
July 19, 2023 Station-Cuartero NHS 11:30 AM 12:30: PM Motorcycle 200.00 200.00
Cuartero NHS-Station 5:00 PM 6:45 PM Motorcycle 200.00 200.00
400.00
TOTAL 400.00
1) I HEREBY CERTIFFY that I have reviewed the foregoing itinerary. Prepared by:
(2) the trtavel is necessary to service. (3) the period covered is reasonable
(4) the expense claimed are proper.
ALDEN M. DACLES
Teacher I
Approved by:
ANALEA E. FUENTES
Supervisor/Immediate Supervisor ANALEA E. FUENTES
Principal I

APPENDIX B
ANALEA E. FUENTES Date: July 19, 2023
Principal I Station: San Antonio NHS

I hereby certicy that I have completed the travel authhoorized in the iterinary of travel No. _________
Dated________________________________ under the conditions indicated below.
X Strictly with accordance with the prepared iterinary
Cut short eexplained below, excess payment in the amount of
was refunded under OR No. dated.
Extended as explained below. Additional iterinary was submitted:
Other deviation was explained below.

Attach supporting documents: Certiificate of Appearance, Travel Order.

On evidence and information of which I have knowledge, the travel undertaken.
Resspectfully Submitted:

ALDEN M. DACLES
Teacher I

ANALEA E. FUENTES
Principal I
 ANNEX A

Department of Education
Region VI - Western Visayas
Schools Division of Capiz
Roxas City

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS

Pursuant to COA Circular No. 2017-001- dated June 19, 2017
Name of Employee MARIAN ERA B. HORLADOR Employee No. 6350194
Office SAN ANTONIO NATIONAL HIGH SCHOOL
Division CAPIZ
Particulars Amount ((₱)
Meal Allowance July 24, 2023 250.00
Meal Allowance July 25, 2023 250.00
Meal Allowance July 26, 2023 250.00
Meal Allowance July 27, 2023 250.00
Meal Allowance July 28, 2023 250.00
Meal Allowance July 29, 2023 250.00
Meal Allowance July 31, 2023 250.00
Meal Allowance August 01, 2023 250.00
Meal Allowance August 02, 2023 250.00
Meal Allowance August 03, 2023 250.00
Meal Allowance August 07, 2023 250.00
Meal Allowance August 08, 2023 250.00
Meal Allowance August 09, 2023 250.00
Meal Allowance August 10, 2023 250.00
Meal Allowance August 11, 2023 250.00
Meal Allowance August 14, 2023 250.00
Meal Allowance August 15, 2023 250.00
Meal Allowance August 16, 2023 250.00
Meal Allowance August 17, 2023 250.00
Meal Allowance August 18, 2023 250.00
Meal Allowance August 21, 2023 250.00
Meal Allowance August 22, 2023 250.00
Meal Allowance August 23, 2023 250.00
Meal Allowance August 24, 2023 250.00
Meal Allowance August 25, 2023 250.00
TOTAL 6,250.00
Purpose

Meal Allowance during the conduction National Learning Camp 2023 (Intervention) from July 24, 2023 to
August 25, 2023.

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 receipts. And that I am fully aware that wilful falsification of statements is
punishable by law.
Certified Correct: Noted By:
Signature:
Printed Name: MARIAN ERA B. HORLADOR ANALEA E. FUENTES
Employee Immediate Supervisor
Date 25 August 2023 Date
 s
Roxas city Term.-Kapis Mansion R.C.

Per Diem

Kapis Mansion R.C. - Roxas City Term

p Roxas city Term.-Capiz Division Office, Banica, R.C.

Per Diem

Capiz Division Office, Banica, R.C. - Roxas City Term

Station - Capelco, Cuartero, Capiz

Capelco, Cuartero, Capiz - Station

 APPENDIX A
Date: March 12, 2023
ITINERARY OF TRAVEL
Name: ALDEN M. DACLES Position: Teacher I
Official Station: SAN ANTONIO NATIONAL HIGH SCHOOL Monthly Salary: P 27,000.00
Purpose of travel: To attend 2023 Capiz Division Meet as Coach.

Date Place to Visit Departure Arrival Means of Fare Per TOTAL

Transpotation Diem
March 11, 2023 Station-Maayon L3 Terminal 6:00 AM 6:15 AM Motorcycle 100.00 100.00
Maayon L3 Terminal-Roxas Terminal 6:15 AM 7:15 AM L300 Van 75.00 75.00
Roxas City Term.-Villareal Stadium, Roxas City 7:15 AM 7:30AM Tricycle 40.00 40.00
Villareal Stadium, Roxas City-Roxas City Term 5:00 PM 5:15 PM Tricycle 40.00 40.00
Roxas City Term. -Maayon L300 Terminal 5:15 PM 6:15 PM L300 Van 75.00 75.00
Maayon L3 Terminal-Station 6:15 PM 6:45 PM Motorcycle 100.00 100.00
430.00
March 12, 2023 Station-Maayon L3 Terminal 6:00 AM 6:15 AM Motorcycle 100.00 100.00
Maayon L3 Terminal-Roxas Terminal 6:15 AM 7:15 AM L300 Van 75.00 75.00
Roxas City Term.-Villareal Stadium, Roxas City 7:15 AM 7:30AM Tricycle 40.00 40.00
Villareal Stadium, Roxas City-Roxas City Term 5:00 PM 5:15 PM Tricycle 40.00 40.00
Roxas City Term. -Maayon L300 Terminal 5:15 PM 6:15 PM L300 Van 75.00 75.00
Maayon L3 Terminal-Station 6:15 PM 6:45 PM Motorcycle 100.00 100.00
430.00
TOTAL 860.00
1) I HEREBY CERTIFFY that I have reviewed the foregoing itinerary. Prepared by:
(2) the trtavel is necessary to service. (3) the period covered is reasonable
(4) the expense claimed are proper.
ALDEN M. DACLES
Teacher I
Approved by:
LOURDES V. PALIGUMBA
Supervisor/Immediate Supervisor LOURDES V. PALIGUMBA
Principal I

APPENDIX B
LOURDES V. PALIGUMBA Date: March 12, 2023
Principal I Station: San Antonio NHS

I hereby certicy that I have completed the travel authhoorized in the iterinary of travel No. _________
Dated________________________________ under the conditions indicated below.
X Strictly with accordance with the prepared iterinary
Cut short eexplained below, excess payment in the amount of
was refunded under OR No. dated.
Extended as explained below. Additional iterinary was submitted:
Other deviation was explained below.

Attach supporting documents: Certiificate of Appearance, Travel Order.

On evidence and information of which I have knowledge, the travel undertaken. Resspectfully Submitted:

ALDEN M. DACLES
Teacher I

LOURDES V. PALIGUMBA
Principal I
 ANNEX A

Department of Education
Region VI - Western Visayas
Schools Division of Capiz
Roxas City

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS

Pursuant to COA Circular No. 2017-001- dated June 19, 2017
Name of Employee ALDEN M. DACLES Employee No.
Office SAN ANTONIO NATIONAL HIGH SCHOOL
Division CAPIZ
Particulars Amount ((₱)
Travel (Transportation) March 11, 2023

11-Mar-23 100.00
Maayon L3 Terminal-Roxas Terminal 75.00
Roxas City Term.-Villareal Stadium, Roxas City 40.00
Villareal Stadium, Roxas City-Roxas City Term 40.00
Roxas City Term. -Maayon L300 Terminal 75.00
Maayon L3 Terminal-Station 100.00
430.00
Travel (Transportation) March 12, 2023

Station-Maayon L3 Terminal 100.00

Maayon L3 Terminal-Roxas Terminal 75.00
Roxas City Term.-Villareal Stadium, Roxas City 40.00
Villareal Stadium, Roxas City-Roxas City Term 40.00
Roxas City Term. -Maayon L300 Terminal 75.00
Maayon L3 Terminal-Station 100.00
430.00

TOTAL 860.00
Purpose

To attend 2023 Capiz Division Meet as Coach.

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 receipts. And that I am fully aware that wilful falsification of statements is
punishable by law.
Certified Correct: Noted By:
Signature:
Printed Name: ALDEN M. DACLES LOURDES V. PALIGUMBA
Employee Immediate Supervisor
Date March 12, 2023 Date
 s
Roxas city Term.-Kapis Mansion R.C.

Per Diem

Kapis Mansion R.C. - Roxas City Term

p Roxas city Term.-Capiz Division Office, Banica, R.C.

Per Diem

Capiz Division Office, Banica, R.C. - Roxas City Term

Station - Capelco, Cuartero, Capiz

Capelco, Cuartero, Capiz - Station

 APPENDIX A
Date: March 19, 2023
ITINERARY OF TRAVEL
Name: ALDEN M. DACLES Position: Teacher I
Official Station: SAN ANTONIO NATIONAL HIGH SCHOOL Monthly Salary: P 27,000.00
Purpose of travel: To attend HUMSS Pedagogical Summit on Least Learned Compentencies.

Date Place to Visit Departure Arrival Means of Fare Per TOTAL

Transpotation Diem
March 17, 2023 Station-Maayon L3 Terminal 3:00 PM 3:15 PM Motorcycle 100.00 100.00
Maayon L3 Terminal-Roxas Terminal 3:15 PM 4:30 PM L300 Van 75.00 75.00
Roxas City Term.-El Circulo Convention Center, R.C. 4:30 PM 4:50 PM Tricycle 40.00 40.00
215.00
March 19, 2023 El Circulo Convention Center, R.C.-Roxas City Term 5:00 PM 5:15 PM Tricycle 40.00 40.00
Roxas City Term. -Maayon L300 Terminal 5:15 PM 6:15 PM L300 Van 75.00 75.00
Maayon L3 Terminal-Station 6:15 PM 6:45 PM Motorcycle 100.00 100.00
215.00
TOTAL 430.00
1) I HEREBY CERTIFFY that I have reviewed the foregoing itinerary. Prepared by:
(2) the trtavel is necessary to service. (3) the period covered is reasonable
(4) the expense claimed are proper.
ALDEN M. DACLES
Teacher I
Approved by:
LOURDES V. PALIGUMBA
Supervisor/Immediate Supervisor LOURDES V. PALIGUMBA
Principal I

APPENDIX B
LOURDES V. PALIGUMBA Date: March 19, 2023
Principal I Station: San Antonio NHS

I hereby certicy that I have completed the travel authhoorized in the iterinary of travel No. _________
Dated________________________________ under the conditions indicated below.
X Strictly with accordance with the prepared iterinary
Cut short eexplained below, excess payment in the amount of
was refunded under OR No. dated.
Extended as explained below. Additional iterinary was submitted:
Other deviation was explained below.

Attach supporting documents: Certiificate of Appearance, Travel Order.

On evidence and information of which I have knowledge, the travel undertaken. Resspectfully Submitted:

ALDEN M. DACLES
Teacher I

LOURDES V. PALIGUMBA
Principal I
 ANNEX A

Department of Education
Region VI - Western Visayas
Schools Division of Capiz
Roxas City

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS

Pursuant to COA Circular No. 2017-001- dated June 19, 2017
Name of Employee ALDEN M. DACLES Employee No.
Office SAN ANTONIO NATIONAL HIGH SCHOOL
Division CAPIZ
Particulars Amount ((₱)
Travel (Transportation) March 17, 2023

11-Mar-23 100.00
Maayon L3 Terminal-Roxas Terminal 75.00
Roxas City Term.-El Circulo Convention Center, R.C. 40.00
215.00
Travel (Transportation) 19 March 2023

El Circulo Convention Center, R.C.-Roxas City Term 40.00

Roxas City Term. -Maayon L300 Terminal 75.00
Maayon L3 Terminal-Station 100.00
215.00

TOTAL 430.00
Purpose

To attend HUMSS Pedagogical Summit on Least Learned Compentencies.

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 receipts. And that I am fully aware that wilful falsification of statements is
punishable by law.
Certified Correct: Noted By:
Signature:
Printed Name: ALDEN M. DACLES LOURDES V. PALIGUMBA
Employee Immediate Supervisor
Date 19 March 2023 Date
s
Roxas city Term.-Kapis Mansion R.C.

Per Diem

Kapis Mansion R.C. - Roxas City Term

Station - Capelco, Cuartero, Capiz