Republic of the Philippines DEPARTMENT OF EDUCATION i . Region XII Division of General Santos City Tiongson St., Lagao, General Santos City August 29, 2019 DIVISION MEMORANDUM OSDS NO._(da_s, 2019 STANDARDIZATION OF FORMS FOR MOOE AND SBFP LQUIDATION REPORT AND DISBURSEMENT VOUCHER FOR ELEMENTARY AND SECONDARY SCHOOLS To: Public Schools District Supervisors/Principal In-Charge Principals/School Heads of Public Elementary and Secondary Schools Schools and Divisions’ Finance Staff In line with the goal to be an ISO certifiable, this office is standardizing all forms to be used in the release of MOOE Cash Advances and Liquidation Reports. As such, you are hereby advised to use the standard form effective immediately upon official release of this memorandum, Attached are the following sample templates; 2.1 Liquidation Report Form (to be printed in 5 copies; 2 copies for request of cash advance and 3 copies for the liquidation report using white long bond paper) 2.2 Cash Disbursement Register (to be printed in 5 copies; 2 copies for request of cash advance and 3 copies for the liquidation report using white long bond paper) 2.3 Report of Disbursement (to be printed in 5 copies; 2 copies for request of cash advance and 3 copies for the liquidation report using white long bond Paper) 2.4 Disbursement Voucher (to be printed in 4 copies using white long bond paper) “Serbisyong Heneral, Dekslidad at Marangal” Telephone Nos: 083-552-8907; 552-8909 Email Address: depedgensan@deped.gov.ph GSC-DIT-GF-LHead, vr. 01.00, Effective 08/09/2019Republic of the Philippines DEPARTMENT OF EDUCATION : Region XII Division of General Santos City Tiongson St., Lagao, General Santos City 3. 5. All forms shall use the Arial Font Style with Font size 12. ‘opy Of the above-mentioned forms is available at the Accounting Unit of this ion. For your information and guidance. Regional Director And concurrent Officer-InCharge of the Schools Division Superintendent epee pare} santos Cy Bitton, fakords Section RELEASED Tracking Ke: Ua AN DateTime /5ih ne et ACC2019-09-03-10:43-14-471968 *Serbisyong Heneral, Dekalidad at Marangal”Republic of the Philippines. |Fund Cluster = DEPARTMENT OF EDUCATION Region XI! Division of General Santos City Mgeeeere Tiongson St., Lagao, General Santos City_ Date: DISBURSEMENT VOUCHER OV No. : 101-19- (SCHOOL NAME) in the amount of eset Jos creck [“]commercial Check X]A08 — [Jothors (tease specity if MOOE-Principal and Partner, If SBFP - | TiwEmployee No [ORS/BURS No Principal and Feeding Coordinator Jadcress [PVE Savings AccH (General Santos City Ee Responsibly Particulars cape MFOIPAP Amount To release Cash Advance for various school expenses chargeable against 2019 MOOE/SBFP Allotment of ELEMENTARY - 261008020500002 Position Month of Release [Total Amount Due = JA] Cerlfied: Expenses/Gash Advance necessary, lawful and Incurred under my direct supervision. PROGRAM HOLDERIPRINCIPAL, [BJ Accounting Entry: ‘Recount Tie UACS Code_[ Debt Credit |Advances for Operating Expenses 1-99-01-010-00 - Cash, Modified Disdursement System - Regular 10104040 00 - C|Certified: [D Approved for Payment 4 Cash avaliable Subject to Authority to Debit Account (when applicable) Supporting documents complete and amount claimed proper Signature Signature panes TOMAS J, PETALLANA JR., CPA Nane_| MARIO M. BERMUDEZ, CESO VI Accountant Ill Assistant Schools Division Superintendent Festion | "Head, Accounting UnivAuthorized Representatwe | "°°" |~ Agency Head Authorised Reyrosentave Date Date Receipt of Payment [EV No. Check Date [Bank Name & Account ADA No. Number Date iTMOOE-Principarand [Date aa Partner; if SBFP - Principal [Official Receipt No. & Date/Other DocumentsRepublic of the Philippines DEPARTMENT OF EDUCATION Region XII Division of General Santos City Tiongson St., Lagao, General Santos City LIQUIDATION REPORT Serial No. Period Covered Date: Entity Name Fund Cluster : Responsibility Center Code: [ PARTICULARS AMOUNT ‘OTAL AMOUNT SPENT a MOUNT OF CASH ADVANCE PER DV NO. DID. [AMOUNT REFUNDED PERORNO,____D1D.______| |AMOUNT TO BE REIMBURSED. A |Cettitied: Correctness of the B J eriiied: Purpose of travel [Ay ‘erified: Supporting documents above data cash advance duly accomplished complete and proper ADAS IlI/ MOOE - Principal Disbursing Officer SBFP - Head Nurse Tomas J. Petallana Jr., CPA Signature over Printed Name | Signature over Printed Name | Signature over Printed Name Position Position Head, Accounting Division Unit JJEV No. Date: Date: Date:Annex G-12 - Republika ng Pilipinas DEPARTMENT OF EDUCATION Rehiyon XII Tiongson St., Lagao, General Santos City REPORT OF DISBURSEMENTS Report No. Sheet No.: Period Covered: ‘Amount No, | Dat lat int Pai 10.|Date| Reference Received | _ Nature of Payment Amount Paid CERTIFICATION | certify that this Report of Disbursement in age/s is a full, ue and correct statement of the disbursement made by me and that this is in liquidation of the cash advance granted last. in the amount of, Per ADA no, dated Principal ‘Signature over Printed Name Date SubmittedRepublic of the Philippines DEPARTMENT OF EDUCATION Region XIl Division of General Santos City Tiongson St, Lagao, General Santos City CASH DISBURSEMENTS REGISTER Name of Accountable Official Designation: Officer: Anpendic 43, Sheet No. : T ir Tavances for Operating Expenses BREAKDOWN OF PAYMENTS (19e0 Date | DvNumber | Particulars ‘Ameunt Gee | ee es eee one |e OTHERS suppies | flectiaty | | Wate | cra Matera apes - = cash |paymens| saance | PETS Expenses Wobie | vce | GAS | vance Deszrpton | Pls 1 | eR e GorosoIG) | (Go704020) | (eODoIOTO)_| ~SOAOTIAD) zl F lof the ‘Breakdown of Payments’ columns. “The Total of the “Advances for Operating Expenses — Payments” column must aways be equalto the Sunol =| CERTIFIED CORRECT: Date: Principal [aaa PoSor emer RECEIVED 8Y: Date: ‘Tomas J. Petallana Jr., CPA Eros eae eogren Accountant lies eee