APPENDIX " A "

LGU - TAMPILISAN, ZAMBO. NORTE

Agency

ITINERARY OF TRAVEL

NAME: SAMSON Q. DOMPALES

POSITION: Revenue Collection Clerk II
OFFICIAL STATION: TAMPILISAN, ZAMBOANGA DEL NORTE
PURPOSE OF TRAVEL: To attend HUDYAKA ZANORTE celebration.

DESTINATION TIME MEANS TRANS.

DATE PER DIEMS TOTAL
FROM TO DEPART. ARRIVAL OF TRANS. EXPENSES
5/16/2011 Station 7:00 AM -
Dipolog City 9:30 Bus 220.00 800.00 1,020.00
-
5/17/2011 Dipolog City 2:00 PM
Station 5:00pm Bus 220.00 320.00 540.00

-
-

-
-

-
-
-
-
-
-
-
-

TOTAL 440.00 1,120.00 1,560.00

I HEREBY CERTIFY that (1) have owned the foregoing itinerary (2) travel is necessary
to the services; the period covered is resonable. The expenses claim are proper.

Prepared by:

SAMSON Q. DOMPALES
Revenue Collection Clerk II
Approved:

OLIVIA G. EBORDE
Municipal Treasurer
Designation
 APPENDIX "B"
CERTIFICATE OF TRAVEL COMPLETED

OLIVIA G. EBORDE
Agency Head

Municipal Treasurer
Designation

I HEREBY CERTIFY that I have completed the travel as authorized in itinerary of Travel
under conditions indicated below.

Strickly with the above itinerary.

x
Cut short unexplained with the approved amount of _________ was refunded on O.R. No.
dated
Extended as explained below, additional itinerary was submitted.
Other deviation as explained below.

Evidence of travel attached the travel Order, Certificate of Appearance,

and other supporting papers hereto attached.

Evidence and information of which I have acknowldege, the travel undertaken.

Respectfully submitted:

SAMSON Q. DOMPALES
Official/Employee

Revenue Collection Clerk II

Designation

APPROVED:

OLIVIA G. EBORDE
(Name & Signature)

Municipal Treasurer
(Designation)
 Republic of the Philippines
PROVINCE OF ZAMBOANGA DEL NORTE
MUNICIPALITY OF TAMPILISAN

OBLIGATION REQUEST No.:

PAYEE SAMSON Q. DOMPALES
OFFICE OFFICE OF THE MUNICIPAL TREASURER
ADDRESS LGU-TAMPILISAN,Z.N.
Responsibilit ACCOUNT
PARTICULARS F.P.P AMOUNT
y Center CODE

Travel Php ###

TOTAL Php ###

A. CERTIFIED: B. CERTIFIED:
Charges to appropriation/allot
lawful and under my dire Existence of available appropriation
Supporting documents valid, pr
Signature Signature

Printed Name OLIVIA G. EBORDE Printed Name GRACE A. GUMANSING

Position Municipal Treasurer OIC Municipal Budget Officer
Date Date

Republic of the Philippines

PROVINCE OF ZAMBOANGA DEL NORTE
MUNICIPALITY OF TAMPILISAN

OBLIGATION REQUEST No.:

PAYEE SAMSON Q. DOMPALES
OFFICE OFFICE OF THE MUNICIPAL TREASURER
ADDRESS LGU-TAMPILISAN,Z.N.
Responsibilit ACCOUNT
PARTICULARS F.P.P AMOUNT
y Center CODE

Travel Php ###

TOTAL Php ###

A. CERTIFIED: B. CERTIFIED:
Charges to appropriation/allot
lawful and under my dire Existence of available appropriation
Supporting documents valid, pr
Signature Signature

Printed Name OLIVIA G. EBORDE Printed Name GRACE A. GUMANSING

Position Municipal Treasurer OIC Municipal Budget Officer
Date Date
 Republic of the Philippines
PROVINCE OF ZAMBOANGA DEL NORTE
MUNICIPALITY OF TAMPILISAN
DISBURSEMENT VOUCHER No.
MODE Check Cash Other
OF
PAYMENT TIN/Employee No.: Obligation Request No.
PAYEE SAMSON Q. DOMPALES
RESPONSIBILITY CENTER
ADDRESS LGU-TAMPILISAN,,ZN
Office/Unit/Project: Code: AMOUNT

To payment of traveling expenses and per diems while

on official travel to attend Hudjaka Zanorte celebration
per supporting papers hereto attached in the amount of 1,560.00

Php. 1,560.00
A T CERTIFIED:
Allotment obligated for the purpose as
Funds Available
Supporting documents complete and p

Signatur
Signature
e
Printed
SEVERINA M. DEYSOLONG Printed Name OLIVIA G.EBORDE
Name
OIC Municipal Accountant Municipal Treasurer
Position Position
(Head,Accounting Unit/Authorized Represent
RECEIVED PAYMENT:
C
Signatur
Check No.:
e
Printed Signature
ENRIQUIETA D. BOMEDIANO
Name Printed Name SAMSON Q. DOMPALES
Municipal Mayor OR. No./Other DocumeJEV No.
Position
(Local Chief Executive/Authorized Represent
FOR ACCOUNTING/PRE-AUDIT SUPPORTING DOCUMENTS FOR COMMON TRANSACTIONS
1 SALARIES TERMINAL LEAVE
1.a FIRST SALARY: Approved application for leave
Appointment duly approved by appointing authority Complete Service Record
Oath of Office Clearance from money,property and legal
Statement of Assets and Liabilities accountability
Copy of transmittal to CSC, if appointment is not yet attested Statement of Assets and Liabilities
Certificate of Assumption Copy of Last Appointment
Certificate of Service or Daily Time Record supported with: If due to retirement, copy of appointment
1.b Monthly regular salary: showing highest salary received, if salary
DTR and/or Punch Card under last appointment is not the highest.
Certified photocopy of log book, if no bundy clock Additional requirement in case of field employees.
Approved Request for exemption, if exempted -Clearance from office of last assignment.
Certificate of Apperance and Travel Order, if on travel RETIREMENT PAY (OPTIONAL)
Approved Application for Leave, in case of absence All under No.4
Accomplishment Report, in case of non-regular employ GSIS retirement Gratuity Adjudication
1.c Additional Requirements in case of transfer: GSIS Certificate of Clearance
Clearance from previous office OVERTIME SERVICES
Certificate of last salary received from former office Authority to render overtime
1.d PROMOTION AND SALARY DIFFERENTIALS Certificate of service or Daily Time Record
Approved appointment or notice of salary adjustment Accomplishment Report, signed by
Certificate of Service or Daily Time Record supported with: employed and the supervisor
Certificate of Assumption Other Personal Services Claims
Daily Time Record & attachments (if any)
2 COMMUTATION & MONETIZATION OF LEAVE
2.a Approved application for leave
Certification of available leave credits
Letter Request (Sick Leave)
2.b COMMUTATION
Clearance, if in excess of thirty days Reviewed by:
Medical Certificate, if sick leave or maternity leave
Marriage contract for first maternity leave.
 LIQUIDATION REPORT
No.: _________
TAMPILISAN,ZAMBOANGA DEL NORTE Date:__________
LGU

To settlement of cash advance for the traveling expenses

while attending NMYL 15th National congresss at Borancay
Island,Malay,Aklan under Voucher no.100-0603-262 dated 03.22.06
per supporting papers hereto attached.

Supporting Documents:
1.Official Receipt for Registration and
Annual Dues O.R.No.2611-03.28.06 8,500.00
2.Certificate of Appearance
3.RER Motorcab Fare from Terminal to Pulawan Wharf Dapitan 150.00
4.RER Motorcab fare from Pulawan Wharf to Terminal 150.00
5.RER Taxi Fare from Boracay wharf to Hotel 680.00
6.RER Taxi Fare from Hotel to Boracay wharf 750.00
7.Admission Fee O.R.#011044 50.00
8.Terminal Fee O.r.#1222135 20.00
9.Boat Fare dated 03.31.06 Ilo-Ilo-Cebu 1,075.20
10.Terminal Fee #21739364 16.50
11.Boat Fare Cebu - Ilo-ilo #004779-03.27.09 975.00
12.Boat fare Cebu - Dapitan #095481-04.01.06 560.00
13.Boat Fare Dapitan- Cebu #2671310-3.26.06 1,100.00
14.Bus Ticket from Station to Dipolog City 160.00
15.Bus ticket from Dipolog City to Station 160.00
16.Taxi Fare from Cebu Wharf to Hotel 360.00
17.Taxi Fare from Hotel to Cebu Wharf 320.00
18.Per diems for 3.27.06,=640.00 640.00
19.Per diems for 3.28.06- / 3.29.06 / 03.30.06 / 03.31.06
4.1.06 5 days 4,000.00
20. per diems 4.2.06 240.00
Total Expenses 19,906.70
19,906.70
TOTAL AMOUNT SPENT 22,037.00
AMOUNT OF CASH ADVANCE PER DV NO.100-00609-169-09.01.06 2,130.30
AMOUNT REFUNDED PER O.R.NO. -0-
AMOUNT TO BE REIMBURSED
SUBMITTED BY: RECEIVED BY:

CELESTE JOIE L.CERNA JULITO P.LADEZA, C.P.A.

Employee Municipal Accountant

09.28.09
Date Date

Republic of the Philippines

PROVINCE OF ZAMBOANGA DEL NORTE
Municipality of Sergio Osmea
OFFICE OF THE MUNICIPAL AGRICULTURIST
 CERTIFICATE OF APPEARANCE

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that the officer / employee whose name and designation

are shown below appeared in this office as indicated and the purpose stated hereunder:
: Lucito P.Cerna
NAME
Municipal Nutrition Action Officer-Designate
DESIGANTION :
: Office of the Mun.Nutrition/ Office of the Mun.Agriculturist
OFFICE
: Tampilisan,ZN
STATION
July 7-10,2004
INCLUSIVE DATES :
Attend ZNACMA Mobile conference
PURPOSE :

MUNICIPAL AGRICULTURIST