Appendix 32

Fund Cluster :
Entity Name
Date :
DISBURSEMENT VOUCHER DV No. :

Mode of MDS Check Commercial Check ADA Others (Please specify)

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee

Address

Responsibility
Particulars MFO/PAP Amount
Center

Amount Due
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

________________________________________
Printed Name, Designation and Signature of Supervisor

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)
Sup
proper

Signature Signature

Printed
Printed Name
Name

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

Date Date

E. Receipt of Payment JEV No.

Check/ Date : Bank Name & Account Number:
ADA No. :
Date : Printed Name: Date
Signature :
Official Receipt No. & Date/Other Documents

92
 Appendix 40

CASH DISBURSEMENTS RECORD

Entity Name : __________________________

Fund Cluster : __________________________ Sheet No. : _________________

___________________ ________________________________ ________________

Accountable Officer Official Designation Station

Cash
Cash
ADA/ UACS Object Advance
Date Payee Nature of Payment Disbursements Advance
Check/DV/ Code Received/
Balance
Payroll/ (Refunded)
Reference No.

CERTIFICATION

I hereby certify on my official oath that the foregoing is a correct and complete record of all cash
disbursements had by me in my capacity as ______(Designation)____ of (Name of Agency) during
the period from _______________ to _______________,inclusive, as indicated in the corresponding columns.

_______________________________
Name and Signature of Disbursing Officer
________________
Date

110
 Appendix 43

CASH DISBURSEMENTS REGISTER

Entity Name: _______________________________________ Name of Accountable Officer: _____________________

Sub-Office/District/Division: __________________________ Official Designation: ____________________________
Municipality/City/Province: ___________________________ Station: _______________________________________
Fund Cluster : ______________________________________ Register No. : __________________________________
Sheet No. : ____________________________________

Advances for
Operating Expenses BREAKDOWN OF PAYMENTS
(19901010)
DV/Payroll/
Date Particulars Amount Salaries and Salaries and Office OTHERS
Check No.
Payments Wages - Wages -Casual/ Supplies
Regular Contractual Expenses UACS
Cash Account
Balance Object Amount
Advance Description
(50101010) (50101020) (50203010) Code
117

Totals

Recapitulation:
UACS
Account Description Amount
Object Code

Total

The total of the ‘Advances for Operating Expenses – Payments’ column must always be equal to the sum of the
totals of the ‘Breakdown of Payments’ columns.
CERTIFIED CORRECT: RECEIVED BY:
________________________
Signature over Printed Name Signature over Printed Name
Date: ____________________ Date: ______________________
 Appendix 44

LIQUIDATION REPORT Serial No.: _________________

Period Covered November 8, 2021_ Date: October 28, 2021

Entity Name : _____________________________________________ Responsibility Center Code:

Fund Cluster : _____________________________________________ __________________________

PARTICULARS AMOUNT

To liquidate CASH ADVANCE for SCHOOL MOOE Downloaded to

65,950.00
TALAUDYONG ELEMENTARY SCHOOL month of November 08,
2021 in the amount of …..

TOTAL AMOUNT SPENT 65,955.91

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 travel / C Certified: Supporting documents
above data cash advance duly accomplished complete and proper

RONELO J. BERMUDEZ FELISIMA G. MURCIA Ph.D. ATTY. RICHANDER G. JAGMIS

Signature over Printed Name Signature over Printed Name Signature over Printed Name
Claimant Immediate Supervisor Head, Accounting Division Unit

JEV No.: ___________________

Date: _February 8, 2021____ Date: _February 8, 2021____ Date: _____________________
 Appendix 45

ITINERARY OF TRAVEL

Entity Name : _____________________

Fund Cluster: ____________________ No.: _______________
Name : ____________________________________________ Date of Travel : _____________________________
Position : __________________________________________ Purpose of Travel : __________________________
Official Station : _____________________________________ ___________________________________________
Places to be visited TIME Means of Transpor Per Total
Date Others
(Destination) Departure Arrival Transportation -station Diem Amount

TOTAL
Prepared by :

I certify that : (1) I have reviewed the foregoing _____________________________________________

itinerary, (2) the travel is necessary to the Signature over Printed Name
service, (3) the period covered is reasonable and
(4) the expenses claimed are proper.
Approved by:

____________________________________ ______________________________________________
Signature over Printed Name Signature over Printed Name
Immediate Supervisor Agency Head/Authorized Representative

121
 Appendix 46

REIMBURSEMENT EXPENSE RECEIPT

Entity Name: _________________ Fund Cluster : ________________

Date : _______________________ RER No. : ___________________

RECEIVED from ______________________________________

(Name)

_________________________________________________ the amount

(Official Designation)

of __________________________________________ (P__________)
(In Words) (in Figures)

in payment for _______________________________________________

(Payments for subsistence, services,

_________________________________________________________
rental or transportation should show inclusive dates,

_________________________________________________________
purpose, distance, inclusive points of travel, etc.)
PAYEE
Name/Signature __________________________________________
Address ________________________________________________

WITNESS
Name/Signature __________________________________________
Address ________________________________________________

123
 Appendix 47

CERTIFICATION OF TRAVEL COMPLETED

Entity Name: _______________________ Fund Cluster: __________

___________________________ ___________________________
Director in-Charge Station

I HEREBY CERTIFY THAT I have completed the travel as authorized in the Travel
Order/Itinerary of Travel No. ________ dated ________ under conditions indicated below:

/ x / Strictly in accordance with the approved itinerary.

/ / Cut short as explained below. Excess payment in the amount of
P_______ was refunded under O. R. No. ________ dated __________
/ / Extended as explained below, additional itinerary was submitted
/ / Other deviation as explained below.

Explanation or justifications:
______________________________________________________________________________
Evidence of travel:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_________________________________________________________________

Respectfully submitted:

_____________________________
Name of Employee

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

Approved:

________________________
Name of Director
Office
 CERTIFICATE OF TRAVEL COMPLETED
(CTC)

INSTRUCTIONS

A. The CTC is a form used by officers/employees concerned to confirm that he/she has completed
the travel or otherwise, based on the approved itinerary. It is one of the supporting documents to
liquidate cash advances for travel. It shall be prepared by fund cluster.
B. This form shall be accomplished as follows:
1. Entity Name – name of the agency/entity
2. Fund Cluster – the fund cluster name/code in accordance with the UACS
3. Director in-Charge – shall be signed by the Director in-Charge of the office
4. Station – the station where the officer/employee is assigned
5. Justification – reason why the travel is not in accordance with the approved itinerary
6. Evidence of travel – documents used, such as plane tickets, boarding passes, certificate o
appearance, etc.
7. Certification – the certification on the report shall be signed by the official/employee who
made the travel on the last sheet of the report after the totals
8. Name of Employee – name and signature of the official/employee who made the travel
9. Approved – signature of the approving officer

C. It shall be prepared in two (2) copies and shall be distributed as follows:

Original – COA Auditor, through the Accounting Division/Unit, together with

 Appendix 60

PURCHASE REQUEST

Entity Name: _______________________ Fund Cluster: __________________

Office/Section : _____________ PR No.: ______________ Date: ____________

_________________________ Responsibility Center Code : ___________

Stock/ Property
Unit Item Description Quantity Unit Cost Total Cost
No.

Purpose: ____________________________________________________________
_______________________________________________________________
_______________________________________________________________

Requested by: Approved by:

Signature : _________________________ ___________________________
Printed Name : _________________________ ___________________________
Designation : _________________________ ___________________________

151
 Appendix 61

PURCHASE ORDER
______________________
Entity Name

Supplier : _____________________________________________ P.O. No. : ____________________________

Address : _____________________________________________ Date : _______________________________
TIN : ________________________________________________ Mode of Procurement : _________________
Gentlemen:
Please furnish this Office the following articles subject to the terms and conditions contained herein:

Place of Delivery : ___________________________________ Delivery Term : ________________________

Date of Delivery : ____________________________________ Payment Term : ________________________

Stock/
Unit Description Quantity Unit Cost Amount
Property No.

(Total Amount in Words)

In case of failure to make the full delivery within the time specified above, a penalty of one-tenth (1/10) of one percent for
every day of delay shall be imposed on the undelivered item/s.

Conforme: Very truly yours,

__________________________ ________________________________
Signature over Printed Name of Supplier
Signature over Printed Name of Authorized Official

___________________________ _____________________________
Date Designation

Fund Cluster : ___________________________________ ORS/BURS No. : ______________________

Funds Available : _________________________________ Date of the ORS/BURS: _______________
Amount : ____________________________
________________________________________
Signature over Printed Name of Chief Accountant/Head of
Accounting Division/Unit

153
 Appendix 71

PROPERTY ACKNOWLEDGMENT RECEIPT

Entity Name : _________________________________

Fund Cluster: ____________________________________ PAR No.: _________________

Property Date
Quantity Unit Description Amount
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

173
 Appendix 62

INSPECTION AND ACCEPTANCE REPORT

Entity Name : ______________________________ Fund Cluster : ___________

Supplier : ______________________________________________ IAR No. : _______________

PO No./Date : ___________________________________________ Date : _________________
Requisitioning Office/Dept. : _______________________________ Invoice No. : ____________
Responsibility Center Code : _______________________________ Date : _________________

Stock/
Description Unit Quantity
Property No.

INSPECTION ACCEPTANCE
Date Inspected : ________________________ Date Received : _____________________

Inspected, verified and found in order as to Complete

quantity and specifications
Partial (pls. specify quantity)

____________________________________________ ___________________________________
Inspection Officer/Inspection Committee Supply and/or Property Custodian
 REGISTRY OF HERITAGE ASSET
(RHA)

INSTRUCTIONS

A. This Registry is used to record and monitor heritage assets owned by the agency/entity
are not recognized in the books of accounts. It shall be maintained by the Accounting
Division/Unit per fund cluster and kept in a perpetual manner.
B. It shall be accomplished as follows:
1. Entity Name – the name of the agency/entity
2. Nature of the Heritage Asset – classifications as to Historical Buildings, Works of Arts
and Archaeological Specimens, Other Heritage Assets
3. Fund Cluster – the fund cluster name/code in accordance with the UACS
4. Sheet No. – the sheet/page number
5. Date – the date of the reference document/s
6. Reference – the reference document/s used in recording the heritage asset such as JEV
7. Description – brief description of the heritage asset owned and controlled by the entity
8. Location – the site where the heritage asset is located and kept
9. Cost–the cost of the heritage asset acquired through purchase, transfers or donations
10. Depreciation – the depreciation expense recognized for the period, if any
11. Impairment Loss – the impairment loss recognized for the period, if any
12. Disposal – the carrying amount of the heritage asset being disposed through transfers
donations or any other means of disposal
13. Restoration and Maintenance – the restoration and maintenance expenses incurred fo
the heritage asset that are capitalizable
14. Balance – the carrying amount of the heritage asset. The acquisition cost less
depreciation and impairment loss recognized, if any, and any disposals. Add any
restoration and maintenance expenses that are capitalizable.
C. The total amount in the Balance Column shall be footed and posted directly in the Summary
every end of the month.