Forms New
Forms New
Forms New
Entity Name: Department of Social Welfare and Development Fund Cluster: _________
INSPECTION ACCEPTANCE
_______________________________________
Inspection Officer/Inspection Committee
RESTITUTO B. MACUTO
Noted by: Regional Director
ALICE VIASON
Chairperson of Inspection Committee
Republic of the Philippines
REGIONAL JUVENILE JUSTICE AND WELFARE COUNCIL
DSWD Field Office VIII Compound, Magsaysay Boulevard, Tacloban City, Leyte
(053) 321-2040; email add: [email protected]
DISTRIBUTION SHEET
for T-shirt
6th JJW Consciuosness Week Celebration
T-shirt Sizes
No. Name Address Signature
Small Medium Large
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MONTHLY WORKPLAN
for the month of November , 2013
24000
To payment of emoluments for the period Jan. 25, 2018, June
MARLENE L. KAHANO
SWO V/OARDA
Printed Name, Designation and Signature of Supervisor
B. Accounting Entry:
Account Title UACS Code Debit Credit
Date Date
E. Receipt of Payment JEV No.
Check/ Date : Bank Name & Account
ADA No. : Number:
Date : Printed Name: Date
Signature :
Official Receipt No. & Date/Other Documents
LIQUIDATION REPORT No.
Date:
REGIONAL JUVENILE JUSTICE AND WELFARE COUNCIL Responsibility Center:
Field Office No. VIII Code
Magsaysay Boulevard, Tacloban City
PARTICULARS Amount
Amount to be Reimbursed
Php632.50
A Certified: Correctness of B Certified: Purpose of travel/Cash C Supporting documents
the above data advanced duly accomplished. complete and proper
NESTOR B. RAMOS LETICIA T. DIOKNO MARY AGNES S. PUSAY
Claimant Immediate Supervisor Head Accounting Unit JEV No.
August 3, 2018
TRAVEL ORDER
No. RJJWC 031
Series of 2018
To:
AGNES E. BUGAL
Social Welfare Officer III
Purpose/s
Approved:
RESTITUTO B. MACUTO
Head of Office
Duly Authorized Representative
esentative
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
Field Office VIII, Magsaysay Boulevard
Tacloban City
PISPISAN
May 11, 2018
Date
TRAVEL ORDER
No. RJJWC 017
Series of 2018
Subject: AMENDMENT
√
x change the date of conduct of
/
change the venue of
Training/seminar/conference/etc.
Date Date
Place Place
Approved by:
RESTITUTO B. MACUTO
Regional Director
Appendix 14
Total 330
B.
A. Certified: Charges to appropriation/budget necessary, Certified: Budget available and utilized for the
lawful and under my direct supervision; and supporting purpose/adjustment necessary as indicated above.
documents valid, proper and legal
C. STATUS OF UTILIZATION
Reference Amount
Balance
BURS/JEV/RCI/ Utilization Payable Payment Not Yet Due Due and Demandable
RADAI/RTRAI No.
Date Particulars (a) (b) (c) (a-b) (b-c)
Demandable
DSWD TRAVEL ORDER FORM NO. 91
Revised-February, 1998
April 6, 2015
CONFIRMATION OF TRAVEL
No. ___________
Series of 2015
To:
ORVILLE C. BERINO
AO II/OIC Head, AU
Purpose/s
It is understood that a report has been submitted upon completion of this travel together with
Certificate of Appearance from each place visited and other documentary evidence of travel.
Recommeding Approval:
MARLENE L. KAHANO
SWO IV/OIC ARDA Approved by:
NESTOR B. RAMOS
OIC Regional Director
REQUISITION AND ISSUE SLIP
pc Mouse, Optical 2
Cart Ink cart, Epson(T6641)Black 24
Cart Ink cart, Espon(T6642)Cyan 8
Cart Ink cart, Epson(T6643)Magenta 8
Cart Ink cart, Epson(T6644)Yellow 8
pack Battery dry cell AA 2pcs blister pack 8
can Air Freshener aersol 280ML/150 g min 24
Bot ALCOHOL ethyl 68%-70% scented 500ml (5ml) 54
pc Clearbook 20 transparent pockets for legal size 2
pc Corresction Tape film base type UL 6m min 250
box Data file box made of chipboard w/ closed ends 6
box ENVELOPE Documentary for legal size docs 1
pc ERASER plastic/rubber for pencil draft/writing 6
pack Folder tag board for legal size documents 8
pc Marker permanent bullet type BLACK 12
pc Marker permanent bullet tpe BLUE 12
pc Marker permanent bullet type RED 12
pad Note Pad stick on 500x76mm (2"x3"')min 12
pad Note Pad stick on 76mmx76mm(3"'x3'')min 12
pad Note Pad strick on 76mmx100mm(3''x4')min 12
box Paper clip vinyl/plastic coat length 32mm min 6
box Paper clip vinyl/plastic coat length 48mm min 6
ream Paper Multi purpose (COPY) A4 70 gsm 80
ream Paper Multi purpose (COPY) Legal 70 gsm 54
box Pencil Lead Eraser wood cased hardness HB 2
pc Philippine National Flag 1
box Rubber band 70mm min lay flat length (#18) 12
pc Sign pen Black Liquid/gel ink 0.5 mm needle tip 200
pc Sign pen BLUE liquid/gel ink o.5mm needle tip 300
pc Sign pen RED liquid/gel ink 0.5mm needle tio 50
pc Stamp pad ink purple or violet 6
Signature
Name MARLENE L. KAHANO CLARITO T. LOGRONIO PAUL ALBIA BERNARDITA MASCARINAS
Designation SWO V/ARDA for Admin. OIC-DC,Admin. Division AA II AAIII
Date
xxxxx
Signature
Name MARLENE L. KAHANO BRIGIDA D. ESPEJO PAUL ALBIA BERNARDITA MASCARINAS
Designation SWO V/ARDA for Admin. Chief Administrative Officer AA II AAIII
Date
CERTIFICATION
To whom it may concern:
Ocean View Hotel and Water Spa, Tolosa Leyte on July 17-19, 2018
(date of appearance)
It is further certified that during the visit/stay of the above mentioned name, this office;
This certification is issued upon request of the interested party for whatever purpose it may
serve.
Done in Oceanview Hotel & Water Spa,Tolosa Leyte on July 19, 2018
(place of issue) (date of issue)
RESTITUTO B. MACUTO
Regional Director
Note:
This certification shall be issued to officials or employees on official travel in accordance to paragraph 1.3 of Memorandum Circular
No. 37, series of 2004 on Austerity Measures and shall be one of the bases for collecting allowance travel expenses.
Date
CERTIFICATE OF APPEARANCE
Purpose:
RESTITUTO B. MACUTO
RJJWC Chair
Date
CERTIFICATE OF APPEARANCE
Purpose:
RESTITUTO B. MACUTO
RJJWC Chair
Focus Group Discussion
July 26, 2017
Bahay Pag-asa, Alang-alang, Leyte
ATTENDANCE SHEET
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Writeshop on drafting of Comprehenisve Local Juvenile Intervention Program (CLJIP)
Alang-Alang, Leyte
August 6, 2018
ATTENDANCE SHEET
Morning Afternoon
No. Printed Name Position Contact Number/Email Office/Address Signature
Address
IN OUT IN
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CLJIP)
Afternoon
Signature
OUT
appendix 45
ITINERARY OF TRAVEL
Entity Name: Department of Education
Government Center, Palo, Leyte
Fund Cluster: No.:
ITINERARY OF TRAVEL
May 18, 2017 FO - EDS 9:30 a.m 9:45 a.m MCH 8.00 8.00
EDS - FO 11:30 a.m 11:55 a.m MCH 8.00 8.00
May 19, 2017 FO - Leyte Paperworld 1:25 p.m 2:35 p.m MCH 8.00 8.00
Leyte Paperworld - EDS 2:40 p.m 3:10 p.m MCH 8.00 8.00
EDS - FO 3:15 p.m 3:30 p.m MCH 8.00 8.00
May 30, 2017 FO - DSWD Ext. Office 3:20 p.m 3:30 p.m MCH 8.00 8.00
DSWD Ext. Office - FO 3:45 p.m 3:50 p.m MCH 8.00 8.00
June 2, 2017 FO - DSWD Ext. Office 9:45 a.m 9:55 p.m MCH 8.00 8.00
DSWD Ext. Office - EDS 10:05 p.m 10:45 p.m MCH 8.00 8.00
EDS - FO 10:50 p.m 11:15 p.m MCH 8.00 8.00
May 22, 2017 FO - DZR Airport 2:30 p.m 3:20 p.m RPV - - -
terminal fee 150.00 150.00
DZR Airport-NAIA Airport 5:55 p.m 7:30 p.m plane - - -
DZR Airport-Mandaluyong City 8:34 p.m 9:30 p.m GrabTaxi 213.00 240.00 453.00
May 23-24, 2017 still @ the venue (Mandaluyong City) 320.00 320.00
May 25, 2017 Mandaluyong City-NAIA Airport 5:30 a.m 8:30 a.m taxi 183.50 183.50
NAIA Airport-DZR Airport 11:00 a.m 12:25 p.m plane - - -
DZR Airport-terminal 1:30 p.m 2:40 p.m MCH 200.00 - 200.00
terminal fee - residence 2:45 p.m 4:40 p.m PUV 50.00 240.00 290.00
June 4, 2017 residence - DZR Airport 2:30 p.m 3:40 p.m MCH/PUJ 200.00 200.00
terminal fee 150.00 150.00
DZR Airport - NAIA Airport 6:00 p.m 7:20 p.m plane
NAIA Airport - Quezon City 7:40 p.m 8:30 p.m Taxi (c/o SWO III Bugal)
June 5-8, 2017 still @ the venue(Quezon City) 640.00 640.00
June 9, 2017 Quezon City - NAIA Airport 12:30 p.m 3:10 p.m Taxi (c/o SWO III Bugal)
NAIA Airport-DZR Airport 3:55 p.m 5:15 p.m plane
DZR Airport - terminal 5:20 p.m 5:45 p.m MCH 200.00 200.00
terminal - residence 5:50 p.m 6:10 p.m PUV 50.00 240.00 290.00
xxxxxxx nothing followsxxxxxx
appendix 45
appendix 45
ITINERARY OF TRAVEL
NATIVIDAD SILORIO
Area Manager
Appendix 47
I HEREBY CERTIFY that I have completed the travel authorized in Travel Order/Itinerary of Travel
No. dated under conditions indicated below:
Cut short as explained below. Excess payment in the amount of Php ________________________ was
was refunded under O.R No._________________________________________________________
Explanations or Justifications:
Flight on the May 22, 2017 (Tacloban-Manila) were moved twice, from
4:20 p.m to 5:20 p.m then at 5:55 p.m due to airport congestion.
Respectfully Submitted :
JOANNA A. BERINO
Administrative Assistant III
On evidences and information of which I have knowledge, the travel was actually taken.
AGNES E.BUGAL
Social Welfare Officer III
INSPECTION AND ACCEPTANCE REPORT
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
Magsaysay Boulevard, Tacloban City
INSPECTION ACCEPTANCE
Date Inspected: Date Received :
AGNES E. BUGAL
Inspector SWO III
INSPECTION AND ACCEPTANCE REPORT
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
Magsaysay Boulevard, Tacloban City
1 pcs Lanyard (with logo, plastic buckle release, royal blue, 1 inch) 75
INSPECTION ACCEPTANCE
Date Inspected: Date Received :
AGNES E. BUGAL
Inspector SWO III
INSPECTION AND ACCEPTANCE REPORT
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
Magsaysay Boulevard, Tacloban City
rjjwcrjjwcrjjwcrjjwc
INSPECTION ACCEPTANCE
Date Inspected: Date Received :
INSPECTION ACCEPTANCE
Date Inspected: Date Received :
xxxxxxxxxxnothing followsxxxxxxxxxxx
INSPECTION ACCEPTANCE
Date Inspected: Date Received :
INSPECTION ACCEPTANCE
Date Inspected: Date Received :
Stock/Prop
erty No.
Unit Item Description Quantity Unit Cost Total Cost
CERTIFYING AUTHORITIES
as to conformity to APP to fund source and conformity to WFP
Maternity
Out-patient (specify)
Others (specify)
d) Commutation
2 days
Inclusive Dates:
AGNES E. BUGAL
August 13-14, 2018 (Signature of Applicant)
6,350.00
Prepared by:
AGNES E. BUGAL
Social Welfare Officeer III
STATEMENT OF ACCOUNT
Nov. 25, 2009 Tempura Haus, Japanese Rest. meal and snack Php 220.00
Nov. 25, 2009 Tempura Haus, Japanese Rest. meal and snack 2,500.00
Nov. 25, 2009 Access Office Systems xerox 20.00
Nov. 25, 2009 Benjamin Cuedas Fare 40.00
Nov. 25, 2009 Nestor Dacatimbang Fare 20.00
Nov. 25, 2009 M. Lorenzo Fare 20.00
Nov. 25, 2009 Enrique Gravoso Fare 50.00
Nov. 25, 2009 Mario Code Fare 12.00
Nov. 25, 2009 Joselito Neri Fare 26.00
Nov. 25, 2009 Zosimo Barado Fare 24.00
Prepared by:
MARLENE L. KAHANO
SWO IV-CBSU Head
STATEMENT OF ACCOUNT
Prepared by:
MARLENE L. KAHANO
SWO IV/OIC-DC Operations Division
STATEMENT OF ACCOUNT
April 27, 2009 Alex Maceda fare(to carry letter to Baybay, Leyte Php 30.00
April 27, 2009 M. Bolega fare (to carry letter to MacArhur, Leyt 20
April 29, 2009 Genaro Macabare fare (from Ritz Tower to Paperworld 12
April 29, 2009 Leyte Paperworld Main bookpapers, etc. 1,686.00
April 29, 2009 Benjamin Puno Fare (from FO to Paperworld) 12
April 28, 2009 Panato Bread Bakery sliced bread Php 32.00
April 28, 2009 leyte Paperworld Main bookpapers, etc. 1,170.00
April 29, 2009 Gaisano Capital coke 19.80
April 29, 2009 KFC, Tacloban City chicken, etc. 134.00
April 29, 2009 Leyte Paperworld Main expanding envelope 600.00
April 29, 2009 Hanz Graphics & Digital Imaging.. energizer battery 170.00
April 29, 2009 Leyte Paperworld Main manila paper, etc. 207.00
April 29, 2009 Leyte Paperworld Main masking tape 28.00
April 29, 2009 Tacloban Celebrity Plaza meals 185.00
April 29, 2009 Terry's Delicacies delicias, etc. 190.00
April 29, 2009 Terry's Delicacies chocolate moron 80.00
April 28, 2009 Mario de la Cruz Fare (from FO to Paperworld) 24.00
April 29, 2009 Godofredo Arcena fare (for 3 pax fr. FO to Ritz) 20.00
April 29, 2009 Renato Penida fare (from FO to Paperworld vice ver 24
April 29, 2009 Alfonso Cinco fare (from Ritz Tower to FO) 14
April 29, 2009 Arturo Villamor fare (from FO to Ritz Tower) 14
April 29, 2009 Willy Villamor fare(from downtown to FO) 18
April 29, 2009 Alfredo Buenas fare(from Rtiz to Hanz) 14
April 29, 2009 Eddie Galangue fare(from Rtiz to downtown for 2 pa 24
April 29, 2009 Pepito de Veyra fare (from Ritz to FO) 12
April 29, 2009 Leyte Paperworld Main ballpen, etc. 240
April 29, 2009 Renato Gozon fare (from Ritz to Leyte Paperworld) 12
Prepared by:
JOCELYN V. PEŇARANDA
SWO III
Certified True and Correct:
MARLENE L. KAHANO
OIC-Chief, Operations Division
ATTY. SIONNE AUJERO-GASPAY
Php 8,800.00
DSWD Field Office VIII DSWD Field Office VIII
Magsaysay Boulevard, Tacloban City Magsaysay Boulevard, Tacloban City
Employee Employee
Distination: Distination:
Purpose: Purpose:
Approved by Approved by
N
Date of Receipt Supplier Particulars Amount e
t
900.00
11/20/17 Ladera Artspot & Advertising 8x6 ft tarpauline & 4x5 ft. tarpaulin 1,360.00
11/22/17 Leyte Paperworld 5 pcs Illustration board & 5 set Oil 650.00
Pastel
Prepared by:
AGNES E. BUGAL
Social Welfare Officer III
APPROVED BUDGET FOR THE CONTRACT
Department of Social Welfare & Development Field Office VIII
Office of the Regional Director
(UNIT/PROGRAM)
Project:
Purchase Request No. :
VAT Unit
Item No. Description Quantity Unit Unit Price Total Cost
Other Taxes Cost
1 Mineral Water 240 jug 30.00 30.00 7,200.00
xxx
MARLENE L. KAHANO MA. THERESA LEONORA B. COSTELO CLARITO T. LOGRONIO BRIGIDA D. ESPEJO
SWO V/ARDA Head, TWG for ABC Supervising Administrative Officer DC-FMD
FUND UTILIZATION REPORT
as of July 26, 2017
June 28, 2017 Joanna A. Berino TEV-May 2-June 9, 2017 Travelling Expenses 1001307 4,076.50 - 4,076.50
July 11, 2017 Heather Plus purchase of steel cabinets, etc equiment 1001311 22,070.72 1,249.28 23,320.00
July 17, 2017 PC Tools Computer Services swivel chair, etc. Office Supplies 1001313 7,418.48 419.92 7,838.40
July 14, 2017 Atty. Eleanor Calumpiano TE-May 23-27, 2017 Travelling Expenses 1001312 1,330.00 - 1,330.00
TOTAL
May 25, 2017 LIBCAP delivery charges (April 4,6,11,12, Postal/Courier 1001303 554.40 34.65
18,26, 2017) Services
May 25, 2017 Agnes. E. Bugal TEV (Jan.-April 2017) Travelling Expenses 1001304 16,679.00 -
Postal/Courier 1001305 187.49 14.11
June 16, 2017 LIBCAP delivery charges Services
15 pcs. Prepaid card for internet internet services 5,240.00
use
June 16, 2017 Leyte Paperworld 1001306 533.84
purchase of prepaid card for communication 4,076.50
communication use expenses
June 28, 2017 EDS labor and materials for the repair 1001308 3,980.00 248.75
repair
June 28, 2017 Joanna A. Berino TEV-May 2-June 9, 2017 Travelling Expenses 1001307 4,076.50 -
July 11, 2017 Heather Plus purchase of steel cabinets, etc equiment 1001311 23,320.00 1,249.28
July 17, 2017 PC Tools Computer Services swivel chair, etc. Office Supplies 1001313 7,838.40 419.92
July 4, 2017 Atty. Eleanor Calumpiano TE-May 23-27, 2017 Travelling Expenses 1001312 1,330.00 -
GRAND TOTAL 72,793.89 521.84
I HEREBY CERTIFY that the Report of Disbursement in one (1) page, in full is true and correct statement of all disbursements made by me and that this is
in liquidation of Fund Transfer granted last March 29, 2017 in the amount of Php 1,637,700.00 .
Prepared by:
JOANNA A. BERINO
Administrative Assistant III
JULIETA S. REDOŇA
OIC,Regional Accountant, AO IV
Approved by:
RESTITUTO B. MACUTO
Regional Director/RJJWC Chair
Verified:
VICTORIA V. LAUZON
State Auditor IV
ADA/Check
Date Payee Particulars Type of Expenses Gross Tax
#
April 17, 2017 Joanna A. Berino TEV (Jan. 3-March 24, 2017) Travelling Expenses 1001301 4,661.00 -
LIBCAP delivery charges(Jan. 1-31, 2017) Postal/Courier 1001302 229.60
April 21, 2017 Services 14.35
May 25, 2017 Agnes. E. Bugal TEV (Jan.-April 2017) Travelling Expenses 1001304 16,679.00 -
Prepared by:
JOANNA A. BERINO
Administrative Assistant III
Certified Correct by:
JULIETA S. REDOŇA
Administrative Officer IV/OIC Head, Actg. Unit
Approved by:
RESTITUTO B. MACUTO
Regional Director
Net Amount
4,661.00
215.25
189.00
393.19
519.75
16,679.00
173.38
9,431.16
1,330.00
New Five Star sign pen, etc Office Supplies 6,898.00
Sophias Way Food 1 meal and 2 snacks training expenses 24,000.00
Center for 2 meetings
Seafoods and Ribs 1 meal and 2 snacks training expenses 24,000.00
Restaurant Warehouse for 2 meetings
70,888.68 71,410.52
215.25
189.00
393.19
519.75
16,679.00
22,657.19
Checklist of Documents (Pre)
for Regular/Special Meeting
Prepared by:
JOANNA A. BERINO
Administrative Assistant III
Noted by:
AGNES E. BUGAL
SWO III
Checklist of Documents (During)
Writeshop on the development of CLJIP to LGUs
July 18-21, 2017
Prepared by:
JOANNA A. BERINO
Administrative Assistant III
Noted by:
AGNES E. BUGAL
SWO III
Prepared by:
JOANNA A. BERINO
Administrative Assistant III
Noted by:
AGNES E. BUGAL
SWO III
Prepared by:
JOANNA A. BERINO
Administrative Assistant III
Noted by:
AGNES E. BUGAL
SWO III
Republic of the Philippines
REGIONAL JUVENILE JUSTICE AND WELFARE COUNCIL
DSWD Field Office VIII Compound, Magsaysay Boulevard, Tacloban City, Leyte
(053) 321-2040; email add: [email protected]; [email protected]
CERTIFICATE OF APPEARANCE
(Signature) (Signature)
PRE-INSPECTION Remarks:
Date Inspected:
Inspection Officer
Republic of the Philippines
REGIONAL JUVENILE JUSTICE AND WELFARE COUNCIL
DSWD Field Office VIII Compound, Magsaysay Boulevard, Tacloban City, Leyte
(053) 321-2040; email add: [email protected]
DISTRIBUTION SHEET
Prepaid Cards for the 3rd and 4th Qtr. 2017 (Comm. and Internet use)
# of Prepaid Cards
Prepaid cards Name & Position Signature
300 100
Agnes E. Bugal, SWO III 22 22
Globe
14 1 15
Joanna A. Berino, AdAsst. III
Smart 3 3
Prepared by:
JOANNA A. BERINO
Administrative Assistant III
Noted by:
AGNES E. BUGAL
SWO III
STATEMENT OF OVERTIME SERVICES RENDERED
Approved for PAYMENT ON THE AMOUNT OF _____________________ the above expenses have
been incurred under my authority in the interest of public service and the charge being just and reasonable
as verify believable.
NESTOR B. RAMOS
Regional Director
STATEMENT OF OVERTIME SERVICES RENDERED
TOTAL OVERTIME
Approved for PAYMENT ON THE AMOUNT OF _____________________ the above expenses have
been incurred under my authority in the interest of public service and the charge being just and reasonable
as verify believable.
NESTOR B. RAMOS
Regional Director
Republic of the Philippines
REGIONAL JUVENILE JUSTICE AND WELFARE COUNCIL
DSWD Field Office VIII Compound, Magsaysay Boulevard, Tacloban City, Leyte
(053) 321-2040; email add: [email protected]
DISTRIBUTION SHEET
Prepaid by:
JOANNA A. BERINO
AdAsst. III
Noted by:
AGNES E. BUGAL
SWO III
Republic of the Philippines
REGIONAL JUVENILE JUSTICE AND WELFARE COUNCIL
DSWD Field Office VIII Compound, Magsaysay Boulevard, Tacloban City, Leyte
(053) 321-2040; email add: [email protected]
DISTRIBUTION SHEET
for internet use for period January to June 2017
15
Prepaid by:
JOANNA A. BERINO
AdAsst. III
Noted by:
AGNES E. BUGAL
SWO III
Republic of the Philippines
REGIONAL JUVENILE JUSTICE AND WELFARE COUNCIL
DSWD Field Office VIII Compound, Magsaysay Boulevard, Tacloban City, Leyte
(053) 321-2040; email add: [email protected]
UNCIL
STATEMENT OF OVERTIME SERVICES RENDERED
Approved for PAYMENT ON THE AMOUNT OF _____________________ the above expenses have
been incurred under my authority in the interest of public service and the charge being just and reasonable
as verify believable.
Approved for PAYMENT ON THE AMOUNT OF _____________________ the above expenses have
been incurred under my authority in the interest of public service and the charge being just and reasonable
as verify believable.
Date: Date:
Employee : Employee :
Time In Time In
Official Personal Time Out Official Personal Time Out
Destination: Destination:
Purpose Purpose
Dates
Name of Member
July 29, 2016 August 3, 2016 August 9, 2016 August 12, 2016
1) Atty. Wilfredo Estorninos
Vice Chairperson, DOJ
2) Atty. Vevelyn Monsanto
Member, PAO
3) Atty. Eleanor Calumpiano
Member, DepEd
4) Atty. Marierose Alvero
Member, CHR
5) Ms. Jenna Negros
DILG
6) Mr. Enrico Baloro
Plan International
7) Ms. Julie Muriel
TESDA
8) SJO2 Eva Naputo
BJMP
9) SP04 Marissa Monge
WCPD, PNP
10) Ms. Chona Bahin
CSWDO
11) Dr. Minerva Molon
DOH
Remarks
No. :
OBLIGATION REQUEST AND STATUS Date:
Payee
JOANNA A. BERINO
Office
2,268.00
Certified: Charges to budget necessary, lawful and under my direct supervision; Certified: Budget available and utilized for the purpose/ adjustment
A. necessary as indicated above.
and supporting documents valid, proper and legal.
Signature Signature
Printed
Printed Name MARLENE L. KAHANO Name BRIGIDA D. ESPEJO
Date Date
C. STATUS OF OBLIGATION
Reference Amount
Date Particulars BURS/JEV/RCI, etc. Obligation Payment Not Yet Due Due and Demendable
Totals
Checklist of Needed Documents:
CERTIFICATE OF APPEARANCE
Date Place/s Visited Purpose Signature & Date