Cerr Deped

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ANNEX A

Republic of the Philippines


DEPARTMENT OF EDUCATION
DIVISION OF SOUTHERN LEYTE
Maasin City, Southern Leyte

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS


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

Name of Employee Employee


No.

Office

Division
Particulars Amount (₱)

TOTAL

Purpose

I hereby certify that the above expenses are incurred as they are necessary for the above cited
purpose, that above good and services were acquired from partied not issuing receipts. And that I
am fully aware that willful falsification of statements is punishable by law.

Certified correct: Noted by:

Signature

Printed Name

Employee Immediate Supervisor


Date Date

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