Appendix 35
LIQUIDATION REPORT Serial No.: ___________
Period Covered ________________ Date: _______________
LGU : ________________________________________ Function/Program/Project
Fund : _______________________________________ _______________________
PARTICULARS Amount
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 C Certified: Supporting documents
above data travel/cash advance duly complete and proper
accomplished
Signature over Printed Name Signature over Printed Name Signature over Printed Name
Claimant Immediate Supervisor Head, Accounting Division Unit
Date:_______________ Date:__________________ Date:__________________