Republic of the Philippines

Department of Education
Region III
DIVISION OF NUEVA ECIJA
Cabanatuan City

Date: ___________________

Checklist - REQUEST FOR ADDITIONAL DEPENDENT

NAME : _____________________________________________
EMPLOYEE NO. : ____________________________________
STATION NO. : ______________________________________
SCHOOL : __________________________________________
DISTRICT : __________________________________________
CLAIM : ____________________________________________
PERIOD : __________________________________________

Please accomplish and arrange in order. Submit documents in two (2) sets.

________ 1 Letter Request of the employee noted by the school principal/PSDS

________ 2 Latest Payslip
________ 3 BIR form 2305 (Completely filled up form)
Important:
Valid ID (govt issued ID's, Passport, Driver's license)
Address
Status of spouse (if unemployed-without TIN; employed abroad-without TIN; employed
locally-TIN of Employer and spouse)

________ 4 Birth Certificates of all dependents

________ 5 Waiver by husband, if not claiming dependent
 Republic of the Philippines
Department of Education
Region III
DIVISION OF NUEVA ECIJA
Cabanatuan City

Date: ___________________

Checklist - PAYROLL INCLUSION OF NEW EMPLOYEE

NAME : _____________________________________________
EMPLOYEE NO. : ____________________________________
STATION NO. : ______________________________________
SCHOOL : __________________________________________
DISTRICT : __________________________________________
CLAIM : ____________________________________________
PERIOD : __________________________________________

Please accomplish and arrange in order. Submit documents in two (2) sets.
________ 1 Letter Request of the employee noted by the school principal/ PSDS
________ 2 Certified true copy of duly approved Appointment/advance copy duly received by CSC
________ 3 Personal Data Sheet (PDS) IMPORTANT: GSIS #,PHILHEALTH#, PAG-IBIG #,TIN #
Copy of Philhealth Member Data Record (MDR) for new members; or if transferred from
________ 4 agency, copy of form ER2 or PMRF form
________ 5 Certificate of first day of service
________ 6 Updated BIR Form 2305
________ 7 Photocopy of ATM Card/ Deposit Slip
________ 8 Transfer Memo, if applicable
 Republic of the Philippines
Department of Education
Region III
DIVISION OF NUEVA ECIJA
Cabanatuan City

Date: ___________________

Checklist - PAYROLL INTEGRATION OF NEW SALARY RATE

NAME : _____________________________________________
EMPLOYEE NO. : ____________________________________
STATION NO. : ______________________________________
SCHOOL : __________________________________________
DISTRICT : __________________________________________
CLAIM : ____________________________________________
PERIOD : __________________________________________

Please accomplish and arrange in order. Submit documents in two (2) sets.
________ 1 Letter Request of the employee noted by the school principal/PSDS
________ 2 Appointment
________ 3 Latest Payslip
________ 4 Copy of NOSI and Plantilla if Step Increment
________ 5 Copy of NOSA if Promotion
 Republic of the Philippines
Department of Education
Region III
DIVISION OF NUEVA ECIJA
Cabanatuan City

___________________________
Date

Checklist - FIRST SALARY

NAME : _____________________________________________
EMPLOYEE NO. : ____________________________________
STATION NO. : ______________________________________
SCHOOL : __________________________________________
DISTRICT : __________________________________________
CLAIM : ____________________________________________
PERIOD : __________________________________________

Please accomplish and arrange in order. Submit documents in two (2) sets.
________ 1 Letter Request of the employee noted by the school principal/PSDS
________ 2 Disbursement Voucher
________ 3 Obligation Request
________ 4 Computation of salary
________ 5 Certified true copy of duly approved Appointment/advance copy duly received by CSC
________ 6 Assignment order, if applicable
________ 7 Certified True copy of Oath of Office
________ 8 Certificate of Assumption
________ 9 Statement of Assets, Liabilities and Net Worth (Notarized)
________ 10 Approved DTR
________ 11 Certification that the teacher concerned has not received any salary for the stated period
________ 12 Certification that the teacher concerned has not incurred leave of absence w/o pay for the stated period
________ 13 Bureau of Internal Revenue (BIR) withholding certificates (Forms 1902 and 2305)
________ 14 Original copy of Personal Data Sheet (PDS) IMPORTANT: TIN #, GSIS#, PHILHEALTH# & PAG-IBIG #
Copy of Philhealth Member Data Record (MDR) for new members; or if transferred from agency, copy of form
________ 15 ER2 or PMRF form
________ 16 Photocopy of ATM card/ Photocopy of Deposit Slip
________ 17 Authority from the claimant and identification documents, if claimed by person other than the payee
________ 18 Copy of updated NOSA, if appointment is not based on new rate
________ 19 Return Endorsement ( if returned to school/ District Office)
 Republic of the Philippines
Department of Education
Region III
DIVISION OF NUEVA ECIJA
Cabanatuan City

___________________________
Date

Checklist -UNPAID SALARY

NAME : _____________________________________________
EMPLOYEE NO. : ____________________________________
STATION NO. : ______________________________________
SCHOOL : __________________________________________
DISTRICT : __________________________________________
CLAIM : ____________________________________________
PERIOD : __________________________________________

Please accomplish and arrange in order. Submit documents in two (2) sets.
________ 1 Letter Request of the employee noted by the school principal/PSDS
________ 2 Disbursement Voucher
________ 3 Obligation Request
________ 4 Computation of salary
________ 5 Certified true copy of duly approved Appointment/advance copy duly received by CSC
________ 6 Approved DTR
________ 7 Photocopy of ATM card/ Photocopy of Deposit Slip
________ 8 Certification that other supporting documents are attached in the first claim
________ 9 Certification that the teacher concerned has not received any salary for the stated period
________ 10 Certification that the teacher concerned has not incurred leave of absence w/o pay for the stated period
Return Endorsement ( if returned to the District Office)
PVP Report (FOR PVP period covered)

Additional Requirements for salary due to heirs if deceased:

________ Clearance from money, property and legal accountabilities

________ Death Certificate authenticated by National Statistics Office (NSO)
________ Marriage contract authenticated by NSO, if applicable
________ Birth Certificate of surviving legal heirs authenticated by NSO
________ Designation of next-of-kin
________ Waiver of right of children 18 years old and above
 Republic of the Philippines
Department of Education
Region III
DIVISION OF NUEVA ECIJA
Cabanatuan City

___________________________
Date

Checklist -UNPAID SALARY, 2nd claim for Senior High School

NAME : _____________________________________________
EMPLOYEE NO. : ____________________________________
STATION NO. : ______________________________________
SCHOOL : __________________________________________
DISTRICT : __________________________________________
CLAIM : ____________________________________________
PERIOD : __________________________________________

Please accomplish and arrange in order. Submit documents in two (2) sets.
________ 1 Letter Request of the employee noted by the school principal/PSDS
________ 2 Disbursement Voucher
________ 3 Obligation Request
________ 4 Computation of salary
________ 5 Certified true copy of duly approved Appointment/advance copy duly received by CSC
________ 6 Approved DTR
________ 7 Photocopy of ATM card/ Photocopy of Deposit Slip
________ 8 Certification that other supporting documents are attached in the first claim
________ 9 Certification that the teacher concerned has not received any salary for the stated period
________ 10 Certification that the teacher concerned has not incurred leave of absence w/o pay for the stated period
Return Endorsement ( if returned to the District Office)
PVP Report (FOR PVP period covered)

Additional Requirements for salary due to heirs if deceased:

________ Clearance from money, property and legal accountabilities

________ Death Certificate authenticated by National Statistics Office (NSO)
________ Marriage contract authenticated by NSO, if applicable
________ Birth Certificate of surviving legal heirs authenticated by NSO
________ Designation of next-of-kin
________ Waiver of right of children 18 years old and above
 Republic of the Philippines
Department of Education
Region III
DIVISION OF NUEVA ECIJA
Cabanatuan City

___________________________
Date

Checklist -LAST SALARY, if retired/separated from service

NAME : _____________________________________________
EMPLOYEE NO. : ____________________________________
STATION NO. : ______________________________________
SCHOOL : __________________________________________
DISTRICT : __________________________________________
CLAIM : ____________________________________________
PERIOD : __________________________________________

Please accomplish and arrange in order. Submit documents in two (2) sets.
________ 1 Letter Request of the employee noted by the school principal
________ 2 Disbursement Voucher
________ 3 Obligation Request
________ 4 Computation of salary
________ 5 Certified true copy of duly approved Appointment
________ 6 Certificate of Assumption
________ 7 Statement of Assets, Liabilities and Net Worth (Notarized)
________ 8 Approved DTR
________ 9 Certification that the teacher concerned has not received any salary for the stated period
________ 10 Certification that the teacher concerned has not incurred leave of absence w/o pay for the stated period
________ 11 Service record indicating date of retirement/separation from service
________ 12 Clearance from money, property and legal accountabilities
________ 13 Photocopy of ATM card/ Photocopy of Deposit Slip
Return Endorsement ( if returned to the District Office)
PVP Report (FOR PVP period covered)

Additional Requirements for salary due to heirs if deceased:

________ Clearance from money, property and legal accountabilities

________ Death Certificate authenticated by National Statistics Office (NSO)
________ Marriage contract authenticated by NSO, if applicable
________ Birth Certificate of surviving legal heirs authenticated by NSO
________ Designation of next-of-kin
________ Waiver of right of children 18 years old and above
 Republic of the Philippines
Department of Education
Region III
DIVISION OF NUEVA ECIJA
Cabanatuan City

___________________________
Date

Checklist -PAYMENT OF SALARY DIFFERENTIAL DUE TO STEP INCREMENT

NAME : _____________________________________________
EMPLOYEE NO. : ____________________________________
STATION NO. : ______________________________________
SCHOOL : __________________________________________
DISTRICT : __________________________________________
CLAIM : ____________________________________________
PERIOD : __________________________________________

Please accomplish and arrange in order. Submit documents in two (2) sets.
________ 1 Letter request for payment by employee concerned noted by the School Head
________ 2 Disbursement Voucher
________ 3 Obligation Request
________ 4 Computation of salary differential
________ 5 Certified true copy of approved Notice of Step Increment
________ 6 Certified true copy of approved Plantilla
________ 7 Certificate of Assumption
________ 8 Approved DTR
________ 9 Certification that the teacher concerned has not received any salary differential for the stated period
________ 10 Certification that the teacher concerned has not incurred leave of absence w/o pay for the stated period
________ 11 Certified true copy of service record
________ 12 Certified true copy of appointment
________ 13 Certified true copy of payslip
________ 14 Photocopy of ATM card/ Photocopy of Deposit Slip
Return Endorsement ( if returned to the District Office)
PVP Report (FOR PVP period covered)

Additional Requirements for salary due to heirs if deceased:

________ Clearance from money, property and legal accountabilities

________ Death Certificate authenticated by National Statistics Office (NSO)
________ Marriage contract authenticated by NSO, if applicable
________ Birth Certificate of surviving legal heirs authenticated by NSO
________ Designation of next-of-kin
________ Waiver of right of children 18 years old and above
 Republic of the Philippines
Department of Education
Region III
DIVISION OF NUEVA ECIJA
Cabanatuan City

___________________________
Date

Checklist -PAYMENT OF SALARY DIFFERENTIAL DUE TO PROMOTION

NAME : _____________________________________________
EMPLOYEE NO. : ____________________________________
STATION NO. : ______________________________________
SCHOOL : __________________________________________
DISTRICT : __________________________________________
CLAIM : ____________________________________________
PERIOD : __________________________________________

Please accomplish and arrange in order. Submit documents in two (2) sets.
________ 1 Letter request for payment by employee concerned noted by the School Head
________ 2 Disbursement Voucher
________ 3 Obligation Request
________ 4 Computation of salary differential
________ 5 Certified true copy of latest approved Appointment/advance copy of Appointment duly received by CSC
________ 6 Notice of Salary Adjustment
________ 7 Certificate of Assumption
________ 8 Approved DTR
________ 9 Certification that the teacher concerned has not received any salary differential for the stated period
________ 10 Certification that the teacher concerned has not incurred leave of absence w/o pay for the stated period
________ 11 Certified true copy of service record
________ 12 Certified true copy of payslip
________ 13 Photocopy of ATM card/ Photocopy of Deposit Slip
Return Endorsement ( if returned to the District Office)
PVP Report (FOR PVP period covered)

Additional Requirements for salary due to heirs if deceased:

________ Clearance from money, property and legal accountabilities

________ Death Certificate authenticated by National Statistics Office (NSO)
________ Marriage contract authenticated by NSO, if applicable
________ Birth Certificate of surviving legal heirs authenticated by NSO
________ Designation of next-of-kin
________ Waiver of right of children 18 years old and above

Additional Requirements for tansferees from one government office to another:

________ Clearance from money, property, and legal accountabilities from the previous office

Certified true copy of pre-audited disbursement voucher of last salary from previous agency and/or Certification
________ by the Chief Accountant of last salary received from previous office duly verified by the asigned auditor thereat
________ BIR form 2316
________ Certificate of Available Leave Credits
________ Service Record
________ Previous Appointment
________ Memorandum: Re Transfer of salary/station
 Republic of the Philippines
Department of Education
Region III
DIVISION OF NUEVA ECIJA
Cabanatuan City
___________________________
Date

Checklist - UNPAID SALARY

IF DELETED FROM PAYROLL WHEN INCURRED LEAVE OF ABSENCE

NAME : _____________________________________________
EMPLOYEE NO. : ____________________________________
STATION NO. : ______________________________________
SCHOOL : __________________________________________
DISTRICT : __________________________________________
CLAIM : ____________________________________________
PERIOD : __________________________________________

Please accomplish and arrange in order. Submit documents in two (2) sets.
________ 1 Letter request for payment by employee concerned noted by the School Head
________ 2 Disbursement Voucher
________ 3 Obligation Request
________ 4 Computation of salary
________ 5 Approved DTR
________ 6 Certification that the teacher concerned has not received any salary for the stated period
________ 7 Certification that the teacher concerned has not incurred leave of absence w/o pay for the stated period
________ 8 Notice of Assumption
________ 9 Approved Application for Leave, Clearances, and Medical Certificate, if on sick leave for five days or more
________ 10 Latest Payslip
________ 11 Special Order (SO) of Return to work order/Reinstatement
 Republic of the Philippines
Department of Education
Region III
DIVISION OF NUEVA ECIJA
Cabanatuan City
___________________________
Date

Checklist - SALARY OF SUBSTITUTE

NAME : _____________________________________________
EMPLOYEE NO. : ____________________________________
STATION NO. : ______________________________________
SCHOOL : __________________________________________
DISTRICT : __________________________________________
CLAIM : ____________________________________________
PERIOD : __________________________________________

Please accomplish and arrange in order. Submit documents in two (2) sets.
________ 1 Letter request for payment by employee concerned noted by the School Head
________ 2 Disbursement Voucher
________ 3 Obligation Request
________ 4 Computation of salary
________ 5 Approved DTR
________ 6 Certification that the teacher concerned has not received any salary for the stated period
________ 7 Certification that the teacher concerned has not incurred leave of absence w/o pay for the stated period
________ 8 Assumption to Duty
________ 9 Certified true copy of approved Appointment/advance copy of Appointment duly received by CSC
________ 10 Certified True copy of Oath of Office
________ 11 Statement of Assets, Liabilities and Net Worth (Notarized)
________ 12 Personal Data Sheet (PDS) IMPORTANT: TIN #, GSIS#, PHILHEALTH#
________ 13 BIR form 1902 or 2305
Authority from the claimant and identification documents, if claimed by person other than the payee
 Republic of the Philippines
Department of Education
Region III
DIVISION OF NUEVA ECIJA
Cabanatuan City
___________________________
Date

Checklist - MATERNITY LEAVE

NAME : _____________________________________________
EMPLOYEE NO. : ____________________________________
STATION NO. : ______________________________________
SCHOOL : __________________________________________
DISTRICT : __________________________________________
CLAIM : ____________________________________________
PERIOD : __________________________________________

Please accomplish and arrange in order. Submit documents in two (2) sets.
________ 1 Letter request for payment by employee concerned noted by the School Head
________ 2 Disbursement Voucher
________ 3 Obligation Request
________ 4 Computation of salary
________ 5 Certified true copy of approved application for leave
________ 6 Certified true copy of Maternity leave clearance
________ 7 Birth Certificates of the child (If Miscarriage attach HISTO-PATHOLOGY results (if D&C is done))
________ 8 Special Order (SO) of Return to work order/Reinstatement
________ 9 Latest Payslip
________ 10 Certification that the teacher concerned has not received any salary for the stated period
________ 11 Medical certificate for maternity leave
PVP Report (FOR PVP period covered)

Addt'l Requirements for unused maternity leave (upon assumption before the expiration of the 60-day maternity leave)

________ Medical certificate that the employee is physically fit to work

________ Certificate of assumption
________ Approved DTR

Additional Requirements for salary due to heirs if deceased:

________ Clearance from money, property and legal accountabilities

________ Death Certificate authenticated by National Statistics Office (NSO)
________ Marriage contract authenticated by NSO, if applicable
________ Birth Certificate of surviving legal heirs authenticated by NSO
________ Designation of next-of-kin
________ Waiver of right of children 18 years old and above
 Republic of the Philippines
Department of Education
Region III
DIVISION OF NUEVA ECIJA
Cabanatuan City
___________________________
Date

Checklist - PROPORTIONAL VACATION PAY (PVP)

NAME : _____________________________________________
EMPLOYEE NO. : ____________________________________
STATION NO. : ______________________________________
SCHOOL : __________________________________________
DISTRICT : __________________________________________
CLAIM : ____________________________________________
PERIOD : __________________________________________

Please accomplish and arrange in order. Submit documents in two (2) sets.
________ 1 Letter request for payment by employee concerned noted by the School Head
________ 2 Disbursement Voucher
________ 3 Obligation Request
________ 4 Computation of salary
________ 5 Proportional Vacation Pay Report (PVP Report), Teaching / DTR, Non Teaching
________ 6 Certification of Last Salary Received, if retired
________ 7 Certification that the teacher concerned has not received any salary for the stated period
________ 8 Service Record
________ 9 Latest Payslip
 Republic of the Philippines
Department of Education
Region III
DIVISION OF NUEVA ECIJA
Cabanatuan City
___________________________
Date

Checklist - CLOTHING ALLOWANCE

NAME : _____________________________________________
EMPLOYEE NO. : ____________________________________
STATION NO. : ______________________________________
SCHOOL : __________________________________________
DISTRICT : __________________________________________
CLAIM : ____________________________________________
PERIOD : __________________________________________

Please accomplish and arrange in order. Submit documents in two (2) sets.
________ 1 Letter request for payment by employee concerned noted by the School Head
________ 2 Disbursement Voucher
________ 3 Obligation Request
________ 4 Payroll ( Soft and Hard Copy)
________ 5 Findes (Soft Copy)
________ 6 Certification of Leave and Absensces
________ 7 Certification of Retirement
________ 8 Certification of Administrative Cases
 Republic of the Philippines
Department of Education
Region III
DIVISION OF NUEVA ECIJA
Cabanatuan City
___________________________
Date

Checklist - SALARY DIFFERENTIAL (TRANCHES)

NAME : _____________________________________________
EMPLOYEE NO. : ____________________________________
STATION NO. : ______________________________________
SCHOOL : __________________________________________
DISTRICT : __________________________________________
CLAIM : ____________________________________________
PERIOD : __________________________________________

Please accomplish and arrange in order. Submit documents in two (2) sets.
________ 1 Letter request for payment by employee concerned noted by the School Head
________ 2 Disbursement Voucher
________ 3 Obligation Request
________ 4 Payroll for adj.(Current year) - soft and hard copy
________ 5 Notice of Salary Adjustment (NOSA)
________ 6 Updated Service Record
________ 7 Form 48 (January 2017)
________ 8 Latest Appointment
 Republic of the Philippines
Department of Education
Region III
DIVISION OF NUEVA ECIJA
Cabanatuan City
___________________________
Date

Checklist - Year End Bonus

NAME : _____________________________________________
EMPLOYEE NO. : ____________________________________
STATION NO. : ______________________________________
SCHOOL : __________________________________________
DISTRICT : __________________________________________
CLAIM : ____________________________________________
PERIOD : __________________________________________

Please accomplish and arrange in order. Submit documents in two (2) sets.
________ 1 Letter request for payment by employee concerned noted by the School Head
________ 2 Disbursement Voucher
________ 3 Obligation Request
________ 4 FINDES (PAYROLL SYSTEM-LAND BANK OF THE PHILIPPINES) - SOFT & HARD COPY
________ 5 APPROVED YEAR-END BONUS 2017 PAYROLL (SOFT & HARD COPY,SEE ATTACHED FORMAT)
________ 6 CERTIFICATION BY PSDS/HS AS TO LEAVE, TRANSFERRED AND SERVICE RENDERED (SEE ATTACHED FORMAT)
 Republic of the Philippines
Department of Education
Region III
DIVISION OF NUEVA ECIJA
Cabanatuan City
___________________________
Date

Checklist - Productivity Enhancement Incentive

NAME : _____________________________________________
EMPLOYEE NO. : ____________________________________
STATION NO. : ______________________________________
SCHOOL : __________________________________________
DISTRICT : __________________________________________
CLAIM : ____________________________________________
PERIOD : __________________________________________

Please accomplish and arrange in order. Submit documents in two (2) sets.
________ 1 Letter request for payment by employee concerned noted by the School Head
________ 2 Disbursement Voucher
________ 3 Obligation Request
________ 4 FINDES (PAYROLL SYSTEM-LAND BANK OF THE PHILIPPINES) - SOFT & HARD COPY
________ 5 APPROVED PEI 2017 PAYROLL (SOFT & HARD COPY,SEE ATTACHED FORMAT)
________ 6 CERTIFICATION AS TO LEAVE WITHOUT PAY/ TRANSFER TO OR FROM OTHER SCHOOL
 Republic of the Philippines
Department of Education
Region III
DIVISION OF NUEVA ECIJA
Cabanatuan City
___________________________
Date

Checklist - Loyalty

NAME : _____________________________________________
EMPLOYEE NO. : ____________________________________
STATION NO. : ______________________________________
SCHOOL : __________________________________________
DISTRICT : __________________________________________
CLAIM : ____________________________________________
PERIOD : __________________________________________

Please accomplish and arrange in order. Submit documents in two (2) sets.
________ 1 Letter request for payment by employee concerned noted by the School Head
________ 2 Disbursement Voucher
________ 3 Obligation Request
________ 4 FINDES (PAYROLL SYSTEM-LAND BANK OF THE PHILIPPINES) - SOFT & HARD COPY
________ 5 APPROVED LOYALTY CASH AWARD PAYROLL (SOFT & HARD COPY,SEE ATTACHED FORMAT)
________ 6 CERTIFICATION FROM HRMO AS TO LEAVE INCURRED(SEE ATTACHED FORMAT)
 Republic of the Philippines
Department of Education
Region III
DIVISION OF NUEVA ECIJA
Cabanatuan City

Checklist - Monetization of Leave Credits

NAME : _____________________________________________
EMPLOYEE NO. : ____________________________________
STATION NO. : ______________________________________
SCHOOL : __________________________________________
DISTRICT : __________________________________________
CLAIM : ____________________________________________
PERIOD : __________________________________________

Please accomplish and arrange in order. Submit documents in three (3) sets.
________ 1
________ 2
________ 3
________ 4
________ 5
________ 6
 Republic of the Philippines
Department of Education
Region III
DIVISION OF NUEVA ECIJA
Cabanatuan City
___________________________
Date

Checklist - Monetization of Leave Credits

E : _____________________________________________
OYEE NO. : ____________________________________
ON NO. : ______________________________________
OL : __________________________________________
ICT : __________________________________________
M : ____________________________________________
OD : __________________________________________

e accomplish and arrange in order. Submit documents in three (3) sets.

Letter request for payment by employee concerned noted by the School Head
Employee Leave Card
FORM 6 (application for leave)
Copy of NOSA
Latest CSC attested appointments
Latest payslip
Return Endorsement ( if returned to school/ District Office)