Appendix 32

DSWS FIELD OFFICE III 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 MARK KEVIN P. CABRAL

Address CSFP

Responsibility
Particulars MFO/PAP Amount
Center

To reimburse travelling expenses incurred during official travel

#REF!
dated July 3-22, 2016, amounting to……

Attachments
CA, TO, Itirenary of Travel ,RER

Amount Due #REF!

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

MELANIE M. BARNACHEA/RPC
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 ANGELICA L. TURLA MARIBEL M. BLANCO
REGIONAL ACCOUNTANT GASSD CHIEF
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 47

CERTIFICATION OF TRAVEL COMPLETED

Entity Name: DSWD F.O. III Fund Cluster: 002

DIR. MARITES M. MARISTELA, CESO III DSWD F.O. III

Director in-Charge Station

I HEREBY CERTIFY THAT I have completed the travel as authorized in the Travel Orders/
Itinerary of Travel No._2021-09-001_ dated September 1-30, 2021 under conditions indicated below:

/ x / Strictly in accordance with the approved itinerary.

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

Explanation or justifications:
N/A
Evidence of travel:
Itinerary of Travel, Travel Order, Certificate of Appearance, Travel Report
Certificate ofTravel Completed

Respectfully submitted:

JOSHUA C. LAGMAN
Name of Employee

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

Approved:

VENUS F. REBULDELA
Supervisor
 8 Appendix 45

ITINERARY OF TRAVEL

Entity Name : DSWD KALAHI-CIDSS

Fund Cluster: ___002_____________ No.: 2021-09-001

Name : JOSHUA C. LAGMAN Date of Travel : September 01-30, 2021

Position : Technical Faciltator Purpose of Travel : see attached travel order
Official Station : Botolan Municipal Hall
TIME Means of Transpor Per Total
Date Others
Departure Arrival Transportation -station Diem Amount
OS to Sacop 8:00 AM Tricycle 14.00 14.00
Sacop to Inter Jeep 12.00 12.00
Inter to Dau Terminal Jeep 40.00 40.00
Dau Terminal to Tarlac City UV 180.00 180.00
Tarlac City to Camiling Bayan UV 100.00 100.00
Camiling Bayan to Pindangan 1st Tricycle 100.00 100.00
1-Sep-21
Pindangan 1st to Camiling Bayan Tricycle 100.00 100.00
Camiling Bayan to Tarlac City UV 100.00 100.00
Tarlac City to Dau Terminal UV 180.00 180.00
Dau Terminal to Inter Jeep 40.00 40.00
Inter to Sacop Jeep 12.00 12.00
Sacop to OS 5:00 PM Tricycle 14.00 350.00 400.00 764.00
O.S. to Bangan Brgy Hall 7:55 AM Tricycle 65.00 65.00
Bangan B.Hall to Capayawan B.Hall Tricycle 25.00 25.00
24-Sep-21 Capayawan B.Hall to Paco B.Hall Tricycle 65.00 65.00
Paco B.Hall to Tampo B.Hall Tricycle 25.00 25.00
Tampo B.Hall to O.S. 5:00 PM Tricycle 25.00 135.00 160.00
OS to Santiago Highway 7:58 AM Jeep 10.00 10.00
Santiago Highway to Danacbunga Tricycle 60.00 60.00
27-Sep-21
Danacbunga to Santiago Highway Tricycle 60.00 60.00
Santiago Highway to OS 5:05 PM Jeep 10.00 135.00 145.00
OS to Paco B.Hall 7:58 AM Tricycle 25.00 25.00
28-Sep-21 Paco B.Hall to Batonlapoc B.Hall Tricycle 60.00 60.00
Batonlapoc B.Hall to OS 5:01 PM Tricycle 55.00 135.00 190.00
OS to Bangan B Hall 8:00 AM Tricycle 65.00 65.00
29-Sep-21 Bangan B Hall to Capayawan B.Hall Tricycle 25.00 25.00
Capayawan B.Hall to OS 5:00 PM Tricycle 65.00 135.00 200.00
OS to San Miguel B.Hall 8:00 AM Tricycle 55.00 55.00
30-Sep-21 San Miguel B.Hall to Beneg B.Hall Tricycle 25.00 25.00
Beneg B.Hall to OS 5:05 PM Tricycle 60.00 135.00 195.00
TOTAL 3,097.00
Prepared by :
I certify that : (1) I have reviewed the foregoing itinerary, (2) the travel
is necessary to the service, (3) the period covered is reasonable and JOSHUA C. LAGMAN
(4) the expenses claimed are proper. Signature over Printed Name

Approved by:

VILMA R. SERRANO VENUS F. REBULDELA

Signature over Printed Name Signature over Printed Name
Immediate Supervisor Agency Head/Authorized Representative
 ANNEX A . ANNEX A .

DEPARTMENT OF SOCIAL WELARE AND DEVELOPMENT DEPARTMENT OF SOCIAL WELARE AND DEVELOPMENT
FIELD OFFICE III FIELD OFFICE III
D.M. Macapagal Gov’t. Center, Maimpis, City of San Fernando, Pampanga D.M. Macapagal Gov’t. Center, Maimpis, City of San Fernando, Pampanga

CERTIFICATE OF EXPENSES NOT REQUIRED RECEIPTS CERTIFICATE OF EXPENSES NOT REQUIRED RECEIPTS
Pursuant to COA Circular No. 2017-001 dated June 19,2017 Pursuant to COA Circular No. 2017-001 dated June 19,2017

Name of Employee JOSHUA LAGMAN Employee No. 03-11207 Name of Employee JOSHUA LAGMAN Employee No. 03-11207

Office Kalhi-CIDSS-NCDDP Office Kalhi-CIDSS-NCDDP

Division Field Office III Division Field Office III
Date Particulars Mode of Transp. Amount Date Particulars Mode of Transp. Amount
O.S. to Bangan Brgy Hall Tricycle 65.00 September 22, 2021 Meals/Per Diem 135.00
Bangan B.Hall to Capayawan B.Hall Tricycle 25.00
Capayawan B.Hall to Paco B.Hall Tricycle 65.00
Paco B.Hall to Tampo B.Hall Tricycle 25.00
September 22, 2021
Tampo B.Hall to O.S. Tricycle 25.00

TOTAL 205.00 TOTAL 135.00

Purpose: Purpose:

Courtesy Call and Area familiarization. Courtesy Call and Area familiarization.

I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose, that 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 above goods and services were acquired from parties not issuing receipts. And that I am fully aware that
witful falsification of statement is punishable by law. witful falsification of statement is punishable by law.
Certified correct: Noted by: Certified correct: Noted by:

Signature Signature

Printed Name JOSHUA C. LAGMAN VILMA R. SERRANO Printed Name JOSHUA C. LAGMAN VILMA R. SERRANO
Employee Immediate Supervisor Employee Immediate Supervisor
Date Date Date Date
 ANNEX A . ANNEX A .

DEPARTMENT OF SOCIAL WELARE AND DEVELOPMENT DEPARTMENT OF SOCIAL WELARE AND DEVELOPMENT
FIELD OFFICE III FIELD OFFICE III
D.M. Macapagal Gov’t. Center, Maimpis, City of San Fernando, Pampanga D.M. Macapagal Gov’t. Center, Maimpis, City of San Fernando, Pampanga

CERTIFICATE OF EXPENSES NOT REQUIRED RECEIPTS CERTIFICATE OF EXPENSES NOT REQUIRED RECEIPTS
Pursuant to COA Circular No. 2017-001 dated June 19,2017 Pursuant to COA Circular No. 2017-001 dated June 19,2017

Name of Employee JOSHUA LAGMAN Employee No. 03-11207 Name of Employee JOSHUA LAGMAN Employee No. 03-11207

Office Kalhi-CIDSS-NCDDP Office Kalhi-CIDSS-NCDDP

Division Field Office III Division Field Office III
Date Particulars Mode of Transp. Amount Date Particulars Mode of Transp. Amount
OS to Santiago Highway Jeep 10.00 OS to Paco B.Hall Tricycle 25.00
Santiago Highway to Danacbunga Tricycle 60.00 Paco B.Hall to Batonlapoc B.Hall Tricycle 60.00
Danacbunga to Santiago Highway Tricycle 60.00 Batonlapoc B.Hall to OS Tricycle 55.00
28-Sep-21
Santiago Highway to OS Jeep 10.00
27-Sep-21
Meal/Per Diem 135.00 Meal/Per Diem 135.00

TOTAL 275.00 TOTAL 275.00

Purpose: Purpose:

Attend and conduct BDRRMC Meeting. Attend and conduct BDRRMC Meeting.

I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose, that 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 above goods and services were acquired from parties not issuing receipts. And that I am fully aware that
witful falsification of statement is punishable by law. witful falsification of statement is punishable by law.
Certified correct: Noted by: Certified correct: Noted by:

Signature Signature

Printed Name JOSHUA C. LAGMAN VILMA R. SERRANO Printed Name JOSHUA C. LAGMAN VILMA R. SERRANO
Employee Immediate Supervisor Employee Immediate Supervisor
Date Date Date Date
 ANNEX A . ANNEX A .

DEPARTMENT OF SOCIAL WELARE AND DEVELOPMENT DEPARTMENT OF SOCIAL WELARE AND DEVELOPMENT
FIELD OFFICE III FIELD OFFICE III
D.M. Macapagal Gov’t. Center, Maimpis, City of San Fernando, Pampanga D.M. Macapagal Gov’t. Center, Maimpis, City of San Fernando, Pampanga

CERTIFICATE OF EXPENSES NOT REQUIRED RECEIPTS CERTIFICATE OF EXPENSES NOT REQUIRED RECEIPTS
Pursuant to COA Circular No. 2017-001 dated June 19,2017 Pursuant to COA Circular No. 2017-001 dated June 19,2017

Name of Employee JOSHUA LAGMAN Employee No. 03-11207 Name of Employee JOSHUA LAGMAN Employee No. 03-11207

Office Kalhi-CIDSS-NCDDP Office Kalhi-CIDSS-NCDDP

Division Field Office III Division Field Office III
Date Particulars Mode of Transp. Amount Date Particulars Mode of Transp. Amount
OS to Bangan B Hall Tricycle 65.00 OS to San Miguel B.Hall Tricycle 55.00
Bangan B Hall to Capayawan B.Hall Tricycle 25.00 San Miguel B.Hall to Beneg B.Hall Tricycle 25.00
Capayawan B.Hall to OS Tricycle 65.00 30-Sep-21 Beneg B.Hall to OS Tricycle 60.00
29-Sep-21
Meals/Per Diem 135.00 Meals/Per Diem 135.00

TOTAL 290.00 TOTAL 275.00

Purpose: Purpose:

Attend and conduct BDRRMC Meeting. Attend and conduct BDRRMC Meeting.

I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose, that 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 above goods and services were acquired from parties not issuing receipts. And that I am fully aware that
witful falsification of statement is punishable by law. witful falsification of statement is punishable by law.
Certified correct: Noted by: Certified correct: Noted by:

Signature Signature

Printed Name JOSHUA C. LAGMAN VILMA R. SERRANO Printed Name JOSHUA C. LAGMAN VILMA R. SERRANO
Employee Immediate Supervisor Employee Immediate Supervisor
Date Date Date Date
 ANNEX A . ANNEX A .

DEPARTMENT OF SOCIAL WELARE AND DEVELOPMENT DEPARTMENT OF SOCIAL WELARE AND DEVELOPMENT
FIELD OFFICE III FIELD OFFICE III
D.M. Macapagal Gov’t. Center, Maimpis, City of San Fernando, Pampanga D.M. Macapagal Gov’t. Center, Maimpis, City of San Fernando, Pampanga

CERTIFICATE OF EXPENSES NOT REQUIRED RECEIPTS CERTIFICATE OF EXPENSES NOT REQUIRED RECEIPTS
Pursuant to COA Circular No. 2017-001 dated June 19,2017 Pursuant to COA Circular No. 2017-001 dated June 19,2017

Name of Employee JOSHUA LAGMAN Employee No. 03-11207 Name of Employee JOSHUA LAGMAN Employee No. 03-11207

Office Kalhi-CIDSS-NCDDP Office Kalhi-CIDSS-NCDDP

Division Field Office III Division Field Office III
Date Particulars Mode of Transp. Amount Date Particulars Mode of Transp. Amount
OS to Sacop Tricycle 14.00 Tarlac City to Camiling Bayan UV 150.00
Sacop to Inter Jeep 12.00 Camiling Bayan to Pindangan 1st Jeep 100.00
Inter to Dau Terminal Jeep 36.00 20-Aug-21
Dau Terminal to Tarlac City UV 180.00
1-Sep-21

TOTAL 242.00 TOTAL 250.00

Purpose: Purpose:

Attend BDRRMC Meeting regarding Sub Project Implementation. Attend BDRRMC Meeting regarding Sub Project Implementation.

I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose, that 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 above goods and services were acquired from parties not issuing receipts. And that I am fully aware that
witful falsification of statement is punishable by law. witful falsification of statement is punishable by law.
Certified correct: Noted by: Certified correct: Noted by:

Signature Signature

Printed Name JOSHUA C. LAGMAN VILMA R. SERRANO Printed Name JOSHUA C. LAGMAN VILMA R. SERRANO
Employee Immediate Supervisor Employee Immediate Supervisor
Date Date Date Date
 ANNEX A . ANNEX A .

DEPARTMENT OF SOCIAL WELARE AND DEVELOPMENT DEPARTMENT OF SOCIAL WELARE AND DEVELOPMENT
FIELD OFFICE III FIELD OFFICE III
D.M. Macapagal Gov’t. Center, Maimpis, City of San Fernando, Pampanga D.M. Macapagal Gov’t. Center, Maimpis, City of San Fernando, Pampanga

CERTIFICATE OF EXPENSES NOT REQUIRED RECEIPTS CERTIFICATE OF EXPENSES NOT REQUIRED RECEIPTS
Pursuant to COA Circular No. 2017-001 dated June 19,2017 Pursuant to COA Circular No. 2017-001 dated June 19,2017
Name of Employee JOSHUA LAGMAN Employee No. 03-11207 Name of Employee JOSHUA LAGMAN Employee No. 03-11207
Office Kalhi-CIDSS-NCDDP Office Kalhi-CIDSS-NCDDP
Division Field Office III Division Field Office III
Date Particulars Mode of Transp. Amount Date Particulars Mode of Transp. Amount
Pindangan 1st to Camiling Bayan Tricycle 100.00 Tarlac City to Dau Terminal UV 180.00
Camiling Bayan to Tarlac City UV 150.00 Dau Terminal to Inter Jeep 36.00
Inter to Sacop Jeep 12.00
24-Aug-21
24-Aug-21 Sacop to OS Tricycle 14.00

TOTAL 250.00 TOTAL 242.00

Purpose: Purpose:

Attend BDRRMC Meeting regarding Sub Project Implementation. Attend BDRRMC Meeting regarding Sub Project Implementation.

I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose, that 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 above goods and services were acquired from parties not issuing receipts. And that I am fully aware that
witful falsification of statement is punishable by law. witful falsification of statement is punishable by law.
Certified correct: Noted by: Certified correct: Noted by:

Signature Signature

Printed Name JOSHUA C. LAGMAN VILMA R. SERRANO Printed Name JOSHUA C. LAGMAN VILMA R. SERRANO
Employee Immediate Supervisor Employee Immediate Supervisor
Date Date Date Date
 ANNEX A . ANNEX A .

DEPARTMENT OF SOCIAL WELARE AND DEVELOPMENT DEPARTMENT OF SOCIAL WELARE AND DEVELOPMENT
FIELD OFFICE III FIELD OFFICE III
D.M. Macapagal Gov’t. Center, Maimpis, City of San Fernando, Pampanga D.M. Macapagal Gov’t. Center, Maimpis, City of San Fernando, Pampanga

CERTIFICATE OF EXPENSES NOT REQUIRED RECEIPTS CERTIFICATE OF EXPENSES NOT REQUIRED RECEIPTS
Pursuant to COA Circular No. 2017-001 dated June 19,2017 Pursuant to COA Circular No. 2017-001 dated June 19,2017
Name of Employee JOSHUA LAGMAN Employee No. 03-11207 Name of Employee JOSHUA LAGMAN Employee No. 03-11207
Office Kalhi-CIDSS-NCDDP Office Kalhi-CIDSS-NCDDP
Division Field Office III Division Field Office III
Date Particulars Mode of Transp. Amount Date Particulars Mode of Transp. Amount
O.S. to SACOP Tricycle 14.00 Tulaoc to SF Downtown Jeep 17.00
SACOP to SF Downtown Jeep 15.00 SF Downtown to SACOP Jeep 15.00
SF Downtown to Terminal Tricycle 20.00 25-Aug-21 SACOP to DSWD RO III Tricycle 14.00
SF Terminal to Tulaoc Jeep 17.00
25-Aug-21
Tulaoc to San Jose Tricycle 100.00 Meal/Per Diem 135.00
San Jose to Tulaoc Tricycle 100.00

TOTAL 266.00 TOTAL 181.00

Purpose: Purpose:

Secure and Pick up other documents for Cash for Work attachments. Secure and Pick up other documents for Cash for Work attachments.

I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose, that 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 above goods and services were acquired from parties not issuing receipts. And that I am fully aware that
witful falsification of statement is punishable by law. witful falsification of statement is punishable by law.
Certified correct: Noted by: Certified correct: Noted by:

Signature Signature

Printed Name JOSHUA C. LAGMAN VILMA R. SERRANO Printed Name JOSHUA C. LAGMAN VILMA R. SERRANO
Employee Immediate Supervisor Employee Immediate Supervisor
Date Date Date Date
 ANNEX A . ANNEX A .

DEPARTMENT OF SOCIAL WELARE AND DEVELOPMENT DEPARTMENT OF SOCIAL WELARE AND DEVELOPMENT
FIELD OFFICE III FIELD OFFICE III
D.M. Macapagal Gov’t. Center, Maimpis, City of San Fernando, Pampanga D.M. Macapagal Gov’t. Center, Maimpis, City of San Fernando, Pampanga

CERTIFICATE OF EXPENSES NOT REQUIRED RECEIPTS CERTIFICATE OF EXPENSES NOT REQUIRED RECEIPTS
Pursuant to COA Circular No. 2017-001 dated June 19,2017 Pursuant to COA Circular No. 2017-001 dated June 19,2017
Name of Employee JOSHUA LAGMAN Employee No. 03-11207 Name of Employee JOSHUA LAGMAN Employee No. 03-11207
Office Kalhi-CIDSS-NCDDP Office Kalhi-CIDSS-NCDDP
Division Field Office III Division Field Office III
Date Particulars Mode of Transp. Amount Date Particulars Mode of Transp. Amount

TOTAL - TOTAL -
Purpose: Purpose:

Load allowance. Load allowance.

I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose, that 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 above goods and services were acquired from parties not issuing receipts. And that I am fully aware that
witful falsification of statement is punishable by law. witful falsification of statement is punishable by law.
Certified correct: Noted by: Certified correct: Noted by:

Signature Signature

Printed Name JOSHUA C. LAGMAN VILMA R. SERRANO Printed Name JOSHUA C. LAGMAN VILMA R. SERRANO
Employee Immediate Supervisor Employee Immediate Supervisor
Date Date Date Date
 ANNEX A .

DEPARTMENT OF SOCIAL WELARE AND DEVELOPMENT

FIELD OFFICE III
D.M. Macapagal Gov’t. Center, Maimpis, City of San Fernando, Pampanga

CERTIFICATE OF EXPENSES NOT REQUIRED RECEIPTS

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

Name of Employee JOSHUA LAGMAN Employee No. 03-11207

Office Kalhi-CIDSS-NCDDP
Division Field Office III
Date Particulars Mode of Transp. Amount

TOTAL -
Purpose:

Load allowance.

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
witful falsification of statement is punishable by law.
Certified correct: Noted by:

Signature

Printed Name JOSHUA C. LAGMAN VILMA R. SERRANO

Employee Immediate Supervisor
Date Date
 ANNEX A ANNEX A

DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT DG4:J43EPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
Field Office III Field Office III
D.M. Macapagal Gov't Center, Maimpis, City of San Fernando Pampanga D.M. Macapagal Gov't Center, Maimpis, City of San Fernando Pampanga

CERTIFICATE OF EXPENSES NOT REQUIRED RECEIPTS CERTIFICATE OF EXPENSES NOT REQUIRED RECEIPTS
Pursuant to COA Circular No. 2017-001 dated June 19,2017 Pursuant to COA Circular No. 2017-001 dated June 19,2017

Name of Employee JOSHUA C. LAGMAN Employee No. 03-11207 Name of Employee JOSHUA C. LAGMAN Employee No. 03-11207
Office KC NCDDP-RPMO Office KC NCDDP-RPMO
Division Promotive Services Division Division Promotive Services Division
Particulars Amount Particulars Amount

300.00 300.00

TOTAL 300.00 TOTAL 300.00

Purpose: To claim load allowance Purpose: To claim load allowance

I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose, that above goods and services 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. 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: Certified correct: Noted by:

Signature Signature

Printed Name JOSHUA C. LAGMAN VILMA R. SERRANO Printed Name JOSHUA C. LAGMAN VILMA R. SERRANO
Employee Immediate Supervisor Employee Immediate Supervisor
Date Date Date Date