DV. NO.

DISBURSEMENT VOUCHER
Barangay: Anahaw City/ Muni Labo
Tel. No. 585-2483 Province: Cams. Norte
Payee/Office: JOHN PAUL P. ROSALINAS Employee No. Fund:
Address: Labo, C. Norte TIN No.: 441-386-712-00002 MOOE

Particulars Amount

To cash advancethe registration fee and travel allowance of sk chairperson

while attending the the Handbook on the Financial Transactions 12,794.00
of the Sangguniang Kabataan (HFTSK) at Convention Center , San Vicente ,
, Camarines Norte.

TOTAL Php12,794.00
A Certified: B Certified: C Certified:
Existence of available appropriations for the Funds (Cash) available As to validity, propriety, and legality
charges/expenses indicated above of claim

Approved:

Signature: Signature: Signature:

Printed Name: MARIA CHRISTINA C. MOYA Printed Name: CHARIZE MARIE M. LUKBAN Printed Name: JOHN PAUL P. ROSALINAS
Position: Chairman, Committee on Appropriations Position: Barangay Treasurer Position: SK Chairperson
Date: Date: Date:

D Received Payment:

CHARIZE MARIE M. LUKBAN Check No. : Date: ____________

Signature Over Printed Name Bank Name :
Date: _____________ OR Number : Date: ____________
 Payroll
HONORARIUM, JULY 2024
Period Covered
Barangay: Pangpang City/ Municipality : Labo Payroll No.: _________
Tel. No. : Province: Camarines Norte
Compensation Deductions
Salaries& BIR
No. NAME POSITION
Wages- Honoraria Cash Gift Total witholding Others TOTAL
Regular Tax
Jenny H. Narido SKK 3,850.00 3,850.00
Rica Mae A. Talla SKK 3,850.00 3,850.00
Joemike M. Totanes SKK 3,850.00 3,850.00
John Paul Rigon SKK 3,850.00 3,850.00
Rolando Reyes Jr. SKK 3,850.00 3,850.00
Justine Mae Sanchez SKK 3,850.00 3,850.00
John Ryan Ibañez SKK 3,850.00 3,850.00
Catlyn A. Aloc SKC 3,850.00 3,850.00
Jerome N. Villanueva SKT 3,850.00 3,850.00

34650.00 34650.00
A Certified: B C D
Existence of available appropriations Funds (cash) available As to validity, propriety, and legality of claim
for the charges/expenses indicated above
Approved:
For payment
Signature: Signature: Signature: Signature:
Printed Name: RICA MAE A. TALLA Printed Name: JEROME N. VILLANUEVA Printed Name: JOHN MARCK T. RODRIGUEZ Printed Name: JEROME N. VILLANUEV
Position: Chairman, Committee on Appropriati Position: SK Treasurer Position: SK CHAIRPERSON Position: SK Treasurer
Date: Date: Date: Date:
 PAYROLL
INSTRUCTIONS
A. This form shall be accomplished as follows:
1. Period Covered - period covered by the payroll
2. Payroll Number - the payroll shall be numbered as follows:
00 00 000

serial number (one series each year using the three digit code)
month
year
3. No. - entry number in the payroll
4. Name - complete name of the officers/employees covered by the payroll
5. Position - position of officers/employees
6. Compensation:
Salaries and Wages - amount of salaries and wages due the employees
Honoraria - amount corresponding to the honoraria for the period
Blank Space - for other benefits and allowances due the employees
Total - total amount of salaries/honoraria and other compensation due for the period
7. Deductions - amount of deductions from the employees such as BIR Withholding Tax, Others
Total - total amount of deductions
8. Net Amount Due - gross income less total deductions
9. Signature of Recipient - signature of officer/employee receiving the net amount due
10. Box A - certification by the CCA on the existence of available appropriations for the expenses stated
11. Box B - certification by the BT on the availability of funds ( cash)
12. Box C - certification by the PB on the validity, propriety and legality of the claim and approval for payment
13. Box D - to be signed by the BT/Disbursing Officer
B. This form shall be prepared in three copies to be distributed as follows:
Original - BRK to support the SCP
2nd Copy - BT
3rd Copy - BRK
ayroll
ARIUM, JULY 2024
iod Covered
Payroll No.: _________

Signature of
Recipient

JEROME N. VILLANUEVA
SK Treasurer
 PURCHASE ORDER
Barangay : Anahaw City/ Municipality : Labo
Tel. No. : 585-2483 Province : Camarines Norte
Supplier : P. O. No. :
Address : Labo, Camarines Norte Date :
TIN : Mode of Procurement:
Bidding Negotiated Over the Counter
Gentlemen;
Please deliver to this Office the following articles subject to the terms and conditions contained herein:
Place of Delivery : Delivery Term :
Date of Delivery : Payment Term:

Item No. Particulars Unit/ Quantity Unit Cost Amount

ASSORTED BISCUITS 10 PACKS 131.50 1,315.00
JUICE 10 BOX 190.00 1,900.00
PAPER PLATE 2 PACKS 120.00 240.00
DISPOSABLE GLASS 2 PACKS 110.00 220.00
BONDPAPER A4 2 REAM 300.00 600.00
MANILA PAPER 1 ROLL 2,400.00 2,400.00
PEN TOUCH 1 BOX 670.00 670.00
PENCIL 1 BOX 180.00 180.00
BALLPEN 3 BOX 420.00 1,260.00
CRAYONS 1 BOX 120.00 1440.00
ASSORTED CHOCOLATE 3 BOX
300.00
900.00
NOTEBOOK 35 PCS 25.00 875.00
RECORD BOOK 2 PCS 200.00 400.00
VELLUM BOARD 1 PACK 550.00 550.00
CRETIFICATE HOLDER 10 PCS 105.00 1,050.00

TOTAL: 14,000.00
In case of failure to make full delivery within the time specified above, a penalty of one-tenth (1/10)
of one percent for everyday of delay shall be imposed.
Very truly yours,
JOHN PAUL P. ROSALINAS
Signature over Printed Name
SK CHAIRPERSON
Date
Conforme: Existence of Available Appropriations
of ______________________________
JK MULTI-TRADE MARIA CHRISTINA C. MOYA
Signature over Printed Name Signature over Printed Name
Supplier
________________ Chairman, Committee on Appropriations
______________
Date Date
 INSTRUCTIONS
This form shall be accomplished as follows:
1 Supplier / Address/ TIN - name, address and TIN of the supplier
2 P .O. No. - the PO shall be numbered as follows:
00 00 000
serial number (one series each year using a three digit code)
month
year
3 Date - date of PO preparation
4 Mode of Procurement - mode of procurement used such as public building,
negotiated purchase, Procurement Services, etc. as provided under RA 9184
5 Place/date of Delivery - place and definite date/s of delivery. If not stated, it
shall mean the office of the official making the order and the date shall be seven
days after receipt of the PO by the supplier
6 Delivery Term - delivery term i.e. Free on Borad (FOB) destination, FOB
shipping point, etc. In the absence of such term, it shall mean FOB destination
7 Payment Term - specified period required when the delivered goods shall be
paid and discounts allowed, if any, such as 2/10, n/30
8 Unit - unit of measure of the supplies ( i. e. box, bottle, etc.)
9 Particulars - brief description of the supplies/goods ordered
10 Quantity - quantity of goods ordered
11 Unit Cost - cost per unit of the supplies/goods ordered
12 Amount - total amount of the goods ordered (quantity multiplied by unit cost)
13 Penalty Clause - penalty imposed by the barangay in case of non-comliance
with the terms of the PO
14 Signed by - signature of the PB
15 Conforme - signature over printed name of supplier or his representative
signifying his approval to the terms set by the barangay and the date of signing
16 Existence of Available Appropriation - the amount of available appropriation
committed for the purchase. This shall be signed by the CCA
B. This form shall be prepared in three copies to be distributed as follows:
Original - Supplier for conforme to the terms of the PO and
attachment to the DV upon request for payment
2nd copy - BT
3rd copy - BRK
C. In case of negotiated purchase, the Barangay Secretary shall indicate the
Sangguniang Resolution No. under which the SB approved the contract.
.
 PURCHASE ORDER
Barangay : Anahaw City/ Municipality : Labo
Tel. No. : Province : Camarines Norte
Supplier : P. O. No. :
Address : Labo, Camarines Norte Date :
TIN : Mode of Procurement:
Bidding Negotiated Over the Counter
Gentlemen;
Please deliver to this Office the following articles subject to the terms and conditions contained herein:
Place of Delivery : Delivery Term :
Date of Delivery : Payment Term:

Unit/ Quantity
Item No. Particulars Unit Cost Amount
BASKETBALL BALL
VOLLEYBALL BALL
BASKETBALL NET
VOLLEYBALL NET
SCOREBOARD
PAINT LATEX WHITE & YELLOW
PAINT LATEX RED & BLUE
BASKETBALL RING
SCOREBOOK BASKETBALL &
SCOREBOOK VOLLEYBALL

TOTAL Err:520
In case of failure to make full delivery within the time specified above, a penalty of one-tenth (1/10)
of one percent for everyday of delay shall be imposed.
Very truly yours,

JOHN PAUL P. ROSALINAS

Signature over Printed Name
SK CHAIRPERSON
__________________
Date
Conforme: Existence of Available Appropriations
of ______________________________

MARIA CHRISTINA C. MOYA

Signature over Printed Name Signature over Printed Name
Supplier Chairman, Committee on Appropriations
________________ ______________
Date Date

INSTRUCTIONS
This form shall be accomplished as follows:
 1 Supplier / Address/ TIN - name, address and TIN of the supplier
2 P .O. No. - the PO shall be numbered as follows:
00 00 000
serial number (one series each year using a three digit code)
month
year
3 Date - date of PO preparation
4 Mode of Procurement - mode of procurement used such as public building,
negotiated purchase, Procurement Services, etc. as provided under RA 9184
5 Place/date of Delivery - place and definite date/s of delivery. If not stated, it
shall mean the office of the official making the order and the date shall be seven
days after receipt of the PO by the supplier
6 Delivery Term - delivery term i.e. Free on Borad (FOB) destination, FOB
shipping point, etc. In the absence of such term, it shall mean FOB destination
7 Payment Term - specified period required when the delivered goods shall be
paid and discounts allowed, if any, such as 2/10, n/30
8 Unit - unit of measure of the supplies ( i. e. box, bottle, etc.)
9 Particulars - brief description of the supplies/goods ordered
10 Quantity - quantity of goods ordered
11 Unit Cost - cost per unit of the supplies/goods ordered
12 Amount - total amount of the goods ordered (quantity multiplied by unit cost)
13 Penalty Clause - penalty imposed by the barangay in case of non-comliance
with the terms of the PO
14 Signed by - signature of the PB
15 Conforme - signature over printed name of supplier or his representative
signifying his approval to the terms set by the barangay and the date of signing
16 Existence of Available Appropriation - the amount of available appropriation
committed for the purchase. This shall be signed by the CCA
B. This form shall be prepared in three copies to be distributed as follows:
Original - Supplier for conforme to the terms of the PO and
attachment to the DV upon request for payment
2nd copy - BT
3rd copy - BRK
C. In case of negotiated purchase, the Barangay Secretary shall indicate the
Sangguniang Resolution No. under which the SB approved the contract.
 .
Labo
Camarines Norte

Over the Counter

ained herein:

Amount

Err:520

NA C. MOYA
rinted Name
on Appropriations
_____
 PURCHASE REQUEST
Barangay : Anahaw P. R. No.
City/Municipality : Labo Date

REQUISITION
Item Estimated Estimated
Qty. Measurement Item Description
Number Unit Cost Amount
10 PACKS ASSORTED BISCUIT 131.50 1,315.00
10 BOX JUICE 190.00 1,900.00
2 PACKS PAPER PLATE 120.00 240.00
2 PACKS DISPOSABLE GLASS 110.00 220.00
2 REAM BONDPAPER A4 300.00 600.00
1 ROLL MANILA PAPER 2,400.00 2,400.00
1 BOX PEN TOUCH 670.00 670.00
1 BOX PENCIL 180.00 180.00
3 BOX BALLPEN 420.00 1,260.00
1 BOX CRAYONS 120.00 1440.00
3 BOX ASSORTED CHOCOLATE 300.00 900.00
35 PCS NOTEBOOK 25.00 875.00
2 PCS RECORD BOOK 200.00 400.00
1 PACK VELLUM BOARD 550.00 550.00
10 PCS CERTIFICATE HOLDER 105.00 1,050.00

14,000.00

Requested by : Approved:

CHARIZE MARIE M. LUKBAN JOHN PAUL P. ROSALINAS

Signature over printed Name Signature over Printed Name
Requisitioner SANGGUNIANG KABATAAN CHAIRPERSON

Date
HASE REQUEST
STRUCTIONS
A. This form shall be accomplished as follows:
1 P. R. No. - the PR shall be numbered as follows:
00 00 000

serial number (one series each year using the three digit code)
month
year
2 Date - date of PR preparation
3 Item Number - code of the requested goods
4 Quantity - quantity of goods requested
5 Unit - unit of measure of the goods requested ( i.e. box, bottle, etc.)
6 Item Description - brief description of the goods
7 Estimated Unit Cost - the estimated cost per unit of the goods being requested
8 Estimated Amount - estimated total amount of the goods requested (est. quantity
multiplied by est. unit cost)
9 Total Estimated Amount - total estimated amount of all the goods specified in
the request
10 Purpose - a brief explanation on the purpose of the request
11 Requested by - name and signature of the person requesting the purchase of goods
12 Approved by - signature of the PB

B. This form shall be prepared in three copies to be distributed as follows:

Original - to be attached to the PO
2nd copy - Requestor
3rd copy - BT
 LIQUIDATION REPORT
Barangay : Anahaw City/Municipality Labo LR No. :
Accountable Officer: CHARIZE MARIE M. LUKBAN Province Camarines Norte Date:

Particulars Amount

To cash advance the registration fee and travel allowance of sk treasurer while attending the
the Handbook on the Financial Transactions of the Sangguniang Kabataan (HFTSK)
at Convention Center , San Vicente , Camarines Norte. 12,794.00

Total amount spent 12,794.00

Amount of cash advance per
Amount refunded per OR No. ___________________ Dated _______________________
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

Signature : ________________________ Signature : _____________________ Signature : ____________________

Pri CHARIZE MARIE M. LUKBAN Printed N JOHN PAUL P. ROSALINA Printed Name :Charize Marie M. Lukban
Position : SK Treasurer Position : ____SK Chairperson____ Position : _SK Treasurer_
Date : ____________________________ Date : _________________________ Date : ________________________
 PCV No.: _______________
PETTY CASH VOUCHER Date : __________________
Barangay : ____________________________________ City/ Municipality : ________________________
Petty Cash Fund Custodian : ______________________ Province : ________________________________
1. To be filled out upon request 11. To be filled out upon liquidation
Particulars Amount

Total Amount Granted

Total amount Paid per
O.R. No
Bus fare

Amount Refunded/
(Reimbursed) P

A Requested by: C

___________________________ Received refund - ________

Signature over Printed Name Reimbursement Paid
Name of Requestor

Approved by:

___________________________ ___________________________
Signature over Printed Name Signature over Printed Name
Punong Barangay Petty Cash Fund Custodian

B Paid by: D

___________________________ Liquidation Submitted

Signature over Printed Name Reimbursement Received by
Petty Cash Fund Custodian

Cash Received by:

___________________________ ___________________________
Signature over Printed Name Signature over Printed Name
Payee Payee
Date:______________ Date:______________
 PETTY CASH VOUCHER
INSTRUCTIONS
A. This form shall be accomplished as follows:
1. PCV No. - the PCV shall be numbered as follows:
00 00 000
serial number (one series each year using the three digit code)
month
year

2. Date - date of PCV preparation

I. To be filled out upon request
3. Particulars - brief description of the nature of disbursement/expense and
amount of petty cash requested
4. Box A -Requested by - shall be signed by the Requestor

Approved by - shall be signed by the PB

5.Box B - Paid by - shall be signed by the PCFC
Cash Received by - shall be signed by the recipient of cash

II. To be filled out upon liquidation

6. Total Amount Granted - the amount of cash received by the claimant
7. Total Amount Paid Per OR/Invoice No._____ - the total amount paid as
shown in the invoice presented
8. Amount Refunded/Reimbursed - the difference between the total amount
granted less amount spent
9. Box C - the PCFC shall check the appropriate box and affix his signature
10. Box D - the payee shall check the appropriate box and affix his signature

B. Part I shall be filled out upon request of cash and Part II shall be filled out upon
liquidation
C. The PCV shall be prepared in two copies to be distributed as follows:
Original - BRK to support the SPPCV
2nd Copy - Requesting Official
 INSPECTION AND ACCEPTANCE REPORT
Barangay : Anahaw City/Municipality : Labo
Tel. No. : Province : Camarines Norte

Invoice No.: __________ IAR No. : ___________ RIS No. :____

PO No. : __________ Date:_______ Date : _______________ Date : ______________ Date : _____

UNIT DESCRIPTION QUANTITY

PACKS ASSORTED BISCUIT 10
BOX JUICE 10
PACKS PAPER PLATE 2
PACKS DISPOSABLE GLASS 2
REAM BONDPAPER A4 2
ROLL MANILA PAPER 1
BOX PEN TOUCH 1
BOX PENCIL 1
BOX BALLPEN 3
BOX CRAYONS 1
BOX ASSORTED CHOCOLATE 3
PCS NOTEBOOK 35
PCS RECORD BOOK 2
PACKS VELLUM BOARD 1
PCS CERTIFICATE HOLDER 10

INSPECTION ACCEPTANCE
Date Inspected : Date Received:

Inspected, verified as to quantity and Complete

specifications
Partial (Pls. specify quantity received)

ALVIN JOHN O. DIZON CHARIZE MARIE M. LUKBAN

Signature over Printed Name Signature over Printed Name
Authorized Inspector SK Treasurer
 INSPECTION AND ACCEPTANCE REPORT
INSTRUCTIONS
A. This report shall be accomplished as follows:

1. Supplier - name of the supplier

2. PO No. - number of the PO
3. Date - date of the PO
4. Invoice No. - number of the suppliers invoice
5. Date - date of the invoice
6. IAR No. - the IAR shall be numbered as follows:
00 00 000
serial number (one series each year using the three digit code)
month
year
7. Date - date the IAR is prepared
8. RIS No. - the number of RIS
9. RIS Date - the date of the RIS
10.Unit - unit of measurement such as ream, boox, roll, etc. for the items delivered
11. Description - brief description or details of the items delivered
12. Quantity - number of units delivered
B. The IAR shall be prepared in four copies to be distributed as follows:
Original - BRK to support the DV for the payment
2nd Copy - City/Municipal Accountant
3rd Copy - BRK
4th Copy - BT
C. The "Inspection" box shall be signed by the authorized Inspection Officer who
conducted the inspection. The date of inspection shall also be indicated.
D. The receiving Barangay Official shall acknowledge receipt of the items by placing his
name and signature on the "Acceptance" box. He shall indicate whether the delivery is
complete or partial by putting a check mark on the boxes provided. The date of receipt
shall also be indicated.
E. The IAR shall form part of the supporting documents to the claim of the supplier for
payment.
F. Disbursement Voucher shall be prepared only for the items delivered. Undelivered
items, although covered by PO, shall not be paid.
shall acknowledge receipt of the items by placing his
ptance" box. He shall indicate whether the delivery is
heck mark on the boxes provided. The date of receipt

pporting documents to the claim of the supplier for

 REQUISITION AND ISSUE SLIP
Barangay : Anahaw City/Municipality : Labo RIS No. : ________________
Tel. No. : 585-2483 Province : Camarines Norte Date : ___________________

Requisition Issuance
UNIT PARTICULARS QTY AMOUNT REMARKS
STUB AF #51 OFFICIAL RECEIPT P140.00

Purpose : To be used of the Sangguniang Kabataan of Barangay Government of Anahaw, Labo Camarines Norte in
Revenue Collection

A Requested by: B Approved for Issuance: C Received by: D Issued by:

Signature : ________________ ________________ ________________ ________________

Printed Name: JOHN PAUL P. ROSALINAS VIVENCIO Z. MAIGUE JR. CHARIZE MARIE M. LUKBAN BEATRICE ELOISA M. PANDI

Designation : SK Chairperson Municipal Treasurer SK Treasurer ________________

Date : ________________ ________________ ________________ ________________
 INVENTORY CUSTODIAN SLIP
Barangay : Anahaw City/Municipality: Labo ICS No.
Tel. No. : 585-2483 Province : Camarines Norte
Estimated
Quantity Unit Description
Useful Life
1 pc. CABINET white 1 yr

Received by : Issued by :

TERESITA V. ESPINOLA ARIEL B. BONUM

Signature over Printed Name Signature over Printed Name
BNS Punong Barangay
Position Position
_______________ _______________
Date Date
 For Barangay Treasurer/ Designated Property Custodian Use
INVENTORY CUSTODIAN SLIP
INSTRUCTIONS

A. This form shall be accomplished as follows:

1. ICS No. - the ICS shall be numbered as follows:
00 00 000

serial number (one series each year using the three digit code)
month
year
2. Quantity - number of units given to the employee or user of the inventory item
3. Unit - unit of measurement
4. Description - brief description or details including the serial number of the items
issued to the user/employee,
5. Estimated Useful Life - estimated useful life of the item issued as set by COA

B. The ICS shall be prepared in three copies to be distributed as follows:

Original - BT
2nd copy - BRK
3rd copy - Recipient or user of the inventory

C. The recipient or user of the inventory shall sign the Received by portion and
indicate date of receipt. The official issuing the item shall sign the Issued by portion.

D. This shall be used in issuing supplies with estimated useful life of more than
one year but small enough to be considered as PPE.

E. The recipient shall be accountable for the item received during its estimated
useful life as indicated in the ICS.
 WASTE MATERIALS REPORT
Anahaw
Barangay
Place of StorageBrgy. Hall Anahaw Date: November 18, 2013

ITEMS FOR DISPOSAL

RECORD OF SALES
ITEM QTY. UNIT DESCRIPTION
O.R.No. Amount
1 2 pcs. plastic chairs 400.00
2 1 pc. plastic table l,350.00
3 3 pcs. wood chairs small 600.00
4 1 pc. stand fan 1,350.00
5 1 set printer canon 2,350.00
6

Total 6,050.00
Certified Correct: Approved for Disposal :

AURORA P. LAZARO MEDEL P. PORCINCULA

Signature Over Printed Name Signature Over Printed Name
Barangay Treasurer Punong Barangay

CERTIFICATE OF INSPECTION
I hereby certify that the property enumerated above were disposed of as follows:
Item Destroyed
Item Sold at private sale
Item Sold at public auction
Item Transferred without cost to _____________

Property Inspector: Witness to Disposition:

___________________________ ___________________________
Name and Signature Name and Signature
 WASTE MATERIALS REPORT
INSTRUCTIONS

A. This form shall be accomplished as follows:

1. Barangay - name of the barangay
2. Place of Storage - exact location of the items for disposal
3. Date - date of the preparation of report
4. Item - entry number in the report
5. Qty. - number of items being reported as waste materials
6. Unit - unit of measurement
7. Description - name and descritption of item being reported
8. Record of Sales
OR No.- official receipt number covering the sale of waste materials
Amount - amount of waste materials sold based on th OR
9. Total - total amount of sale
10.Certified Correct - name and signature of the Property Officer
11. Approved for Disposal - name and signature of the Punong Barangay

B. CERTIFICATE OF INSPECTION
1. indicate the corresponding item number of the waste materials in the line opposite the mode of
disposition made
2. Property Inspector - name and signature of the concerned Property Inspector
3. Witness to disposition - name and signature of the person authorized to witness the disposition
of the waste materials.

C. This report shall be prepared in three copies to be distributed as follows:

Original - City/Municipal Accountant
2nd copy - BRK
3rd copy - BT/Property Officer
 TRANSFER OF MONEY AND PROPERTY ACCOUNTABILITIES
Barangay : City/Municipality :
Tel. No. : Province :
A. Money
Cash:
No. of Pieces Denominations Amount

Total
Checks:
Drawee Bank Number Date Amount

Total
B. Accountable Forms
Inclusive Serial Nos.
Quantity Name of Forms
From To

C. Property
Quantity Unit Description Property No.

D. Documents (See attached list/s)

See attached list/s
Transferred by : Received by :
I hereby CERTIFY that the above listed item/s were I hereby ACKNOWLEDGE receipt from _____________
acted upon as follows: _________________________the following:
(Name of Accountable Officer)

a. Cash -refunded under OR No. _________ dated ______ a. Property (see attached certified list)

b. Accountable Forms turned over to _______________ b. Accountable Forms (see attached certified list); and…
(Name of recipient)
c. Property -returned/turned over to _________________ c. Financial Documents (see attached certified list)
(Name of recipient)
d. Documents-all documents turned over to(see certified list)

___________________________ ___________________________
Name,Designation and Signature Barangay Treasurer
of Outgoing Accountable Officer
_________________ __________________
Date Date
Witnessed by: Approved by:

___________________________ ___________________________
Barangay Official Punong Barangay
 TRANSFER OF MONEY AND PROPERTY
ACCOUNTABILITY
INSTRUCTIONS

A. This form shall be accomplished as follows:

1. Money:
* Cash
No. of Pieces -quantity
Denomination - example: P 1, 000, P500, etc.
Amount - no. of pieces multiplied by the denomination
Total - total amount of cash
*Checks
Drawee Bank - name of the drawee bank
Number - check number
Date - date of the check
Amount -amount of the check
Total -total amount of the check listed
2. Accountable Forms:
Quantity - quantity of forms
Name of Forms - name of accountable forms under his custody
Inclusive Serial Nos. - the beginning and ending serial numbers
3. Property :
Quantity - number of pieces/units of PPE
Unit - unit of measurement
Description - brief description of the PPE being transferred/received
Property No. - assigned property number of the PPE
4. Documents - lists of all documents under the custody of AO
5. Transferred by - certification of the outgoing AO on the surrender of the money,
property,accountable forms and documents under his custodianship
6. Received by -acknowledgement of the Incoming barangay official on the receipt of the
money, property, accountable forms and documents surrendered by the outgoing AO
7. Witnessed by - to be signed by the Barangay Official who witnessed the turn over
8. Approved by - to be approved by the PB. In case the PB is the AO, the transfer shall
be approved by the City/Municipal Mayor.

B. The TMPA shall be prepared in four copies every time an accountable officer ceases to be
one to be distributed as follows:
Original - Incoming Barangay Official
2nd Copy - BRK
3rd Copy - Outgoing Barangay Official
4th Copy - COA Representative
I hereby ACKNOWLEDGE receipt from _____________
 Barangay ANAHAW
For the month of July 2018

TRANSMITTAL LETTER
Date : ____________
To : Ms./Mr. _________________________
City/Municipal Accountant/Treasurer/Budget Officer
Dear Sir/Madam,
Pursuant to the COA Accounting Circular No. 2006-002 dated December 19, 2006, I hereby
transmit the following reports and supporting schedules for the period indicated therein:
(Check the applicable box)
x Monthly Reports
Year-end Reports
Others
Submitted by:
RHEA B. NAGERA
Barangay Treasurer
Month/Period Remarks
Name of Report/Register/Summary Covered (by the accountant)
A. Monthly Reports (Check applicable box)
/ Cash Receipts and Deposits Register JULY
March 2018
2018
/ Cash on Hand and in Bank Register JULY 2018
/ Check Disbursements Register JULY 2018
/ Cash Disbursements Register JULY 2018
Petty Cash Fund Register JULY 2018
/ Summary of Collections and Deposits JULY 2019
JULY 2018
/ Summary of Collections and Remittance JULY 2018
/ Summary of Checks Issued JULY 2018
2023
/ Summary of Cash Payments JULY 2018
Summary of Paid PCVs
B. Year-end Reports (Check applicable box)
Status of Appropriations, Commitments and Balances
Report on the Physical Count of PPE
Inventory and Inspection Report of Unserviceable
Property
Unpaid Liabilities (supported by bills,DVs, payroll, etc.)
Others, please specify;
C. Others
Please specify:
Liquidation Report
Inspection and Acceptance Report
Bank Statements
Debit/Credit Memo
Others
ACKNOWLEDGEMENT:
I hereby acknowledge receipt of the above documents complete with supporting schedules.
I have noted the following deficiencies in the reports as shown on the remarks above.
Please submit the _____________________ on or before _____________________.
City/Municipal Accountant/Treasurer/Budget Officer Date
 TRANSMITTAL LETTER
INSTRUCTIONS

A. This form shall be accomplished as follows:

1. Date - date of transmittal letter

2. Reports to be submitted - check the applicable box

Monthly Reports
Yearend Reports
Others

3. Monthly Reports
Name of Report/Register/Summary-check the box of the applicable monthly report to be submitted
Month/Period Covered - indicate the month or the period covered by the report
Remarks - notes by the City/Municipal Accountant/Treasurer/Budget Officer, if there are deficiencies
or comments

4. Yearend Reports
Name of Report/Register/Summary-check the box of the applicable yearend report to be submitted
Reports not included on the list shall be enumerated on the blank space under "Others"
Month/Period Covered - indicate the month or the period covered by the report
Remarks - notes by the City/Municipal Accountant/Treasurer/Budget Officer, if there are deficiencies

5. Others - all other reports/records to be submitted which are not specifically identified in 2,3 and 4
above shall be enumerated
Name of Report - report/document submitted
Month/Period Covered - indicate the month or the period covered by the report
Remarks - notes by the City/Municipal Accountant/Treasurer/Budget Officer, if there are deficiencies

6. Acknowledgement - City/Municipal Accountant/Treasurer/Budget Officer shall cehck appropriate

box and sign the report. If deficiencies were noted, he shall indicate the date for the submission of
the required documents/reports.

B. This report shall be prepared in two copies to be distributed as follows:

Original - City/Municipal Accountant
2nd copy - BRK
y-check the box of the applicable monthly report to be submitted

pal Accountant/Treasurer/Budget Officer, if there are deficiencies

y-check the box of the applicable yearend report to be submitted

pal Accountant/Treasurer/Budget Officer, if there are deficiencies

e submitted which are not specifically identified in 2,3 and 4

pal Accountant/Treasurer/Budget Officer, if there are deficiencies

Accountant/Treasurer/Budget Officer shall cehck appropriate

cies were noted, he shall indicate the date for the submission of
 CLEARANCE FROM MONEY, PROPERTY
AND OTHER ACCOUNTABILITIES
A
_______________
Date

TO:
(Name of Punong Barangay)

I hereby apply for clearance from money, property and other accountabilities for:
, effective
(Purpose) (Date of Effectivity)

________________________
Name and Signature of AO

____________________
Position

B VERIFICATION OF ACCOUNTABILITIES
Accountability Remarks/ Signature
1 Money Barangay Treasurer
2 Property Property Custodian
3 Documents Barangay Recordkeeper
4 Accountable Forms Barangay Treasurer
This certifies that the above-named employee This certifies that the above-named employee has:
is clear from money, property and other
accountabilities as specified in Box B hereof. Remaining uncleared accountabilities
Has a record of pending Administrative Case

APPROVED : DISAPPROVED :

_____________________________ _____________________________
Signature over Printed Name Signature over Printed Name
Punong Barangay Punong Barangay

Date of Clearance : _________________ Date Disapproved : ________________

 CLEARANCE FROM MONEY, PROPERTY
AND OTHER ACCOUNTABILITIES
INSTRUCTIONS

A. This form shall be accomplished as follows:

1. Box A:
Date - date of preparation and filing of the clearance
Name of Punong Barangay - to whom the requwst for clearance is addressed
Purpose - reason for the application of clearance
Effectivity - the date the clearance shall be enforced
Name and signature of the AO - name and signature of the requesting barangay official/AO
Position - position of the barangay official/AO
2. Box B: Verification of Barangay Accountabilities
Accountabilities - money, property and documents
Remarks /Signature -comments, if any, of the Barangay Officials and their signatures

3. Approved - The PB shall sign certifying that he employee/AO is cleared from money, property and
other accountabilities.

4. Date - date the clearance was signed

5. Disapproved - The PB shall sign certifying that the employee is not cleared by checking the box for
the applicable reason.

6. Date - date the clearance was disapproved

B. This form shall be prepared in three copies to be distributed as follows:

Original - Requestor
2nd copy - BRK
3rd copy - PB
Has a record of pending Administrative Case