Appendix 32

Fund Cluster:
Republic of the Philippines
Department Of Agrarian Reform Date:
Malaybalay City, Bukidnon Province APRIL 8, 2022
DV No. :
DISBURSEMENT VOUCHER
Mode of
MDS Check Commercial Check ADA Others
Payment

TIN/Employee No. ORS/BURS No.:

Payee JANUS MARI A. ABAN
1003-SPLIT21-006

Address DARPO-BUKIDNON, MALAYBALAY CITY

Responsibility
Particulars MFO/PAP Amount (Php.)
Center

To reimburse actual expenses incurred while on official travel last

APRIL 4-8, 2022 at Talakag, Bukidnon in the amount of
9,285.00

FUND 102-SPLIT
Amount Due P 9,285.00
###
A. Certified : Expenses/Cash Advances necessary, lawful and incurred under my direct supervision.

FATIMA ANIQA T. MACARAMBON

SPLIT-Provincial Project Director

B. Accounting Entry:

Account Title UACS Code Debit Credit

Travelling Expenses - LocalCash-LCCA, LBP

C. Certified : D. Approved for Payment

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

Signature Signature

Printed Name Printed Name

LOURDES M. MAGLUPAY BERNARDITA M. LAZAGA
SPLIT- Project Accountant SPLIT-Adminitrative & Finance Officer
Position Position

Date Date
E. Received Payment JEV No.
Check/ Date Bank Name & Account Number:
ADA No.
Date Printed Name Date
Signature
JANUS MARI A. ABAN
Official Receipt No. & Date/Other Documents
 Appendix 11

OBLIGATION REQUEST AND STATUS Serial No.

DEPT. OF AGRARIAN REFORM-SPLIT Date :
Fund Cluster :

Payee JANUS MARI A. ABAN

Office DARPO-BUKIDNON
Address DARPO-BUKIDNON, MALAYBALAY CITY
Responsibility
Particulars MFO/PAP UACS Object Code Amount (Php.)
Center

To reimburse actual expenses incurred

while on official travel last APRIL 4-8,
9,285.00
2022 at Talakag, Bukidnon in the
amount of

TOTAL 9,285.00
A. Certified: Charges to appropriation/budget B. Certified: Budget available and utilized
necessary, lawful and under my direct supervision, for the purpose/adjustment necessary as
and supporting documents valid, proper and legal. indicated above

Signature: Signature :
Printed Name: FATIMA ANIQA T. MACARAMBON Printed Name : KARENPEARL E. LABIAL
Position: Provincial Project Director Position : SPLIT - Budget Officer
Head, Budget Unit/Authorized
Head, Requesting Office/Authorized Representative Representative

Date: Date :

STATUS OF OBLIGATION
C.
Reference Amount
Balance
Due and
ORS/JEV/CHECK/ADA/TRA Obligation Payable Payment Not Yet
Date Particulars Demandable
No. Due
Demandable
(a) (b) (c) (a-b) (b-c)
 Appendix 45
Republic of the Philippines
Department Of Agrarian Reform
PROVINCIAL AGRARIAN REFORM OFFICE
Malaybalay City, Bukidnon Province
Tel. No. 088-221-2315

Entity Name: No. :

Fund Cluster:
Name: Janus Mari A. Aban Departure Date: APRIL 4, 2022
Position: Legal Officer Arrival Date: APRIL 8, 2022
Field Validation of Collective CLOA,
Official Station: DARPO Bukidnon Purpose of Travel:
Project SPLIT

ITINERARY OF TRAVEL
Place to be visited Time
Transpor Total
DATE Means of transportation Per Diem Others
(Destination) Departure Arrival tation Amount

Station to Malaybalay Terminal 5:00 AM 5:15 AM PUV 10.00 1,810.00

Malaybalay Terminal to CDO AgoraTerminal 5:20 AM 8:00 AM PUV 200.00 200.00
APRIL 4, 2022 CDO Agora Terminal to CDO Limketkai Van
8:15 AM 8:43 AM PUV 95.00 1,800.00 95.00
Terminal
CDO Limketkai Van Terminal to Talakag
8:50 AM 10:21 AM PUV 300.00 300.00
Terminal
Talakag Terminal to DAR Talakag 10:25 AM 10:35 AM PUV 20.00 20.00
APRIL 5, 2022 Still at Talakag _ _ _ 1,800.00 1,800.00
APRIL 6, 2022 Still at Talakag _ _ _ 1,800.00 1,800.00
APRIL 7, 2022 Still at Talakag _ _ _ 1,800.00 1,800.00
DAR Talakag to Talakag Terminal 5:10 PM 5:16 PM PUV 20.00 920.00
Talakag Terminal to CDO Bulua Terminal 5:25 PM 8:04 PM PUV 100.00 100.00
APRIL 8, 2022 CDO Bulua Terminal to CDO Agora Terminal 8:16 PM 8:29 PM PUV 190.00 900.00 190.00
CDO Agora Terminal to Malaybalay Terminal 8:34 PM 11:00 PM PUV 200.00 200.00
Malaybalay Terminal to Station 11:03 PM 11:24 PM PUV 50.00 50.00
Sub-Total 1,185.00 8,100.00 9,285.00
TOTAL 9,285.00
Prepared by: (Official/Employee)

I certify: 1. I have reviewed the forgoing itinerary

2. The travel is necessary to the service
3. The period covered is reasonable JANUS MARI A. ABAN
4. The expenses claimed are proper Employee
Approved by: (Head of Agency)

ENGR. JOCELYN B. VALMORES FATIMA ANIQA T. MACARAMBON

Parcelization Component & Field Validation Team Coordinator PARPO II/ SPLIT-Provincial Project Director
 CERTIFICATE OF TRAVEL COMPLETED

FATIMA ANIQA T. MACARAMBON Station DAR-Bukidnon

PARPO II/ SPLIT-Provincial Project Manager Date: APRIL 8, 2022

I HEREBY CERTIFY THAT I have completed the travel authorized in the Travel Order No.___________
dated APRIL 1, 2022 under the condition/s indicated below:

Strictly in accordance with the approved itinerary.

Cut short as explained below. Excess payment in the amount of P _____________ was refunded
under Official Receipt No. ___________________________ dated _______________________
Extended as explained below. Additional itinerary was submitted.

Other deviations as explained below.

Explanation or justification:

Evidences of Travel :

Used tickets
Certificate of Appearance

Report

JANUS MARI A. ABAN

Employee

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

ENGR. JOCELYN B. VALMORES

Parcelization Component and Field Validation Team Coordinator
 Appendix 46 Appendix 46

REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPT

Entity Name: _________________ Fund Cluster : ___________ Entity Name: _________________ Fund Cluster : ___________
Date : _______________________ RER No. : _______________ Date : _______________________ RER No. : ______________

RECEIVED from JANUS MARI A. ABAN RECEIVED from ______________________________________

(Name) (Name)

_________________________________________________ the amount _________________________________________________ the amount

(Official Designation) (Official Designation)

of __________________________________________ (P__________) of __________________________________________ (P__________)

(In Words) (in Figures) (In Words) (in Figures)

in payment for _______________________________________________ in payment for _______________________________________________

(Payments for subsistence, services, (Payments for subsistence, services,

_________________________________________________________ _________________________________________________________
rental or transportation should show inclusive dates, rental or transportation should show inclusive dates,

_________________________________________________________ _________________________________________________________
purpose, distance, inclusive points of travel, etc.) purpose, distance, inclusive points of travel, etc.)

PAYEE PAYEE

Name/Signature __________________________________________ Name/Signature __________________________________________

Address ________________________________________________ Address ________________________________________________

WITNESS WITNESS
Name/Signature __________________________________________ Name/Signature __________________________________________
Address ________________________________________________ Address ________________________________________________
 CERTIFICATE OF TRAVEL COMPLETED

ENGR. NORBERTO R. PAQUINGAN August 31, 2021

(Agency Head) (Date)

SPLIT-Provincial Project Manager DAR-Bukidnon

(Designation) (Station)

I HEREBY CERTIFY THAT I have completed the travel authorized in the Travel Order Nos. 08-0006 and
08-0061 dated August 17, 2021 under condition/s indicated below:

Strictly in accordance with the approved itinerary.

Cut short as explained below. Excess payment in the amount of P _____________ was refunded under
Official Receipt No. ___________________________ dated _______________________

Extended as explained below. Additional itinerary was submitted.

/ Other deviations as explained below.

Explanation of justification:

August 19, 2021

August 27, 2021

Evidences of Travel :

Used tickets

X Certificate of Appearance

Report

JANUS MARI A. ABAN

Employee

On evidence and information of which I have acknowledged, the travel was actually undertaken.
ENGR. JOCELYN B. VALMORES
Parcelization Component & Field
Validation Team Coordinator
 Annex A
Republic of the Philippines
#REF!
#REF!
#REF!

CERTIFICATION Of EXPENSES NOT REQUIRING RECIEPTS

Pursuant to COA Circular No. 2017-001 dated June 19, 2017

Name of Employee: #REF! Employee No.:

Office/Division #REF! 1003-SPLIT21-006
Particulars
Date Mode of Transportation Amount (Php)
Station to Malaybalay Terminal TRICYCLE 10.00
Malaybalay Terminal to CDO AgoraTerminal VAN 200.00
CDO Agora Terminal to CDO Limketkai Van
95.00
Terminal TAXI
CDO Limketkai Van Terminal to Talakag
VAN 300.00
August 20, 2021 Terminal
Talakag Terminal to DAR Talakag HABAL-HABAL 20.00
DAR Talakag to Talakag Terminal HABAL-HABAL 20.00
Talakag Terminal to CDO Bulua Terminal VAN 100.00
CDO Bulua Terminal to CDO Agora Terminal TAXI 190.00
CDO Agora Terminal to Malaybalay Terminal VAN 200.00
Malaybalay Terminal to Station TRICYCLE (PAKYAW) 50.00
Station to Malaybalay Terminal TRICYCLE 10.00
Malaybalay Terminal to CDO AgoraTerminal VAN 200.00
CDO Agora Terminal to CDO Limketkai Van
95.00
August 23, 2021 Terminal TAXI
CDO Limketkai Van Terminal to Talakag
VAN 300.00
Terminal
Talakag Terminal to DAR Talakag HABAL-HABAL 20.00
DAR Talakag to Talakag Terminal HABAL-HABAL 20.00
Talakag Terminal to CDO Bulua Terminal VAN 100.00
August 26, 2021 CDO Bulua Terminal to CDO Agora Terminal 190.00
TAXI
CDO Agora Terminal to Malaybalay Terminal VAN 200.00
Malaybalay Terminal to Station TRICYCLE (PAKYAW) 50.00

Total 2,370.00
Purpose:
#REF!

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 willful falsification of statements is punishable by law.

Certified Correct: Noted by:

Signature

Printed Name JANUS MARI A. ABAN ENGR. JOCELYN B. VALMORES

Employee Parcelization Component & FVT Cooordinator

Date
 EXPENSE MONITORING FORM

Control No. ___________________________ Unit _______________ Dare Release___________________

ROA No. ____________ CENRO/PENRO _________ Date of Check ____________________
Date Prepared _____________ Fund ____________________
PAYEE: JANUS MARI A. ABAN

Activity Activity Amount Annual Actual Amount

Purpose
Code Description Requested Utilization Disbursed

To reimburse actual expenses incurred

while on official travel last APRIL 4-8,
9,285.00
2022 at Talakag, Bukidnon in the
amount of

Prepared by: Recommended for Approved by:

Approval:

ALAN M. RINIBATAN AMRON B. ACAMPONG MAMACAYA M. LUCMAN, AL-HAJ

EMS II/ APASu PASU-BKPLS PENR Officer

EXPENSE MONITORING FORM

Control No. ___________________________ Unit _______________ Dare Release___________________

ROA No. ____________ CENRO/PENRO _________ Date of Check ____________________
Date Prepared _____________ Fund ____________________
PAYEE: JANUS MARI A. ABAN

Activity Activity Amount Annual Actual Amount

Purpose
Code Description Requested Utilization Disbursed

To reimburse actual expenses incurred while

on official travel last APRIL 4-8, 2022 at 9,285.00
Talakag, Bukidnon in the amount of

Prepared by: Recommended for Approved by:

Approval:

ALAN M. RINIBATAN #REF! MAMACAYA M. LUCMAN, AL-HAJ

EMS II/ APASu PASU-BKPLS PENR Officer
 Appendix 32
Fund Cluster:
Republic of the Philippines
Department of Environment and Natural Resources Date:
Regional Office No. 10 DV No. :

DISBURSEMENT VOUCHER

Mode of
MDS Check Commercial Check ADA Others
Payment

TIN/Employee No. ORS/BURS No.:

Payee #REF!

Address DENR,CENRO ILIGAN

Responsibility
Particulars MFO/PAP Amount
Center
To Claim Payment for cell card allowance and
communication expenses for the month of June 2017
as per attached OFFICIAL RECEIPT P 800.00
in the total amount of

P 800.00
A. Certified : Expenses/Cash Advances necessary, lawful and incurred under my direct supervision.

MAMACAYA M. LUCMAN
PENR Officer
B. Accounting Entry:

Account Title UACS Code Debit Credit

C. Certified : D. Approved for Payment

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

Signature Signature

Printed Name ASKARI T. DIMAPORO Printed Name MAMACAYA M. LUCMAN, AL-HAJ

Accountant III PENR Officer/PASu

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

Date Date
E. Received Payment JEV No.
Check/ Date Bank Name & Account Number:
ADA No.
Date Printed Name Date
Signature
#REF!
Official Receipt No. & Date/Other Documents
 BUDGET UTILIZATION REQUEST AND STATUS Serial No.
Department of Environment and Natural Resources Region-10 Date :
PENR Office, Pigcarangan, Tubod, Lanao del Norte Fund Cluster :

Payee REYNALDO A. BENEDICTOS

Office DENR , CENR ILIGAN
Address Tubod Rosario Heights,Iligan City
Responsibility
Particulars MFO/PAP UACS Object Code Amount
Center

Communication 800.00

TOTAL 800.00
A. Certified: Charges to appropriation/budget B. Certified: Budget available and utilized
necessary, lawful and under my direct supervision, for the purpose/adjustment necessary as
and supporting documents valid, proper and legal. indicated above

Signature Signature :
Printed Name MAMACAYA M. LUCMAN, AL-HAJ Printed Name : ELIZABETH A. OMAHOY
Position PENR Officer Position :
Head, Requesting Office/Authorized Head, Budget Unit/Authorized
Representative Representative
Date Date :

STATUS OF UTILIZATION
C.
Reference Amount
Balance
BURS/JEV/RCI/ Due and
Date Particulars Utilization Payable Payment Not Yet Demandable
RADAI/RTRAI No.
Due Demandable