LA UNION SCHOOLS DIVISION OFFICE

REGION I
2500, CITY OF SAN FERNANDO, LA UNION
Tel. No. (072) 607-8127 // 242-8127 // 700-4188

Annex A

AUTHORITY TO TRAVEL
Control No: _____

REGION: I
BUREAU/DIVISION/SCHOOL: DepEd/ La Union/ LUNA NATIONAL
VOCATIONAL HIGH SCHOOL
Date of Filing January 15, 2020

NAME and SIGNATURE JUMAR A. BALDREZ

Position / Designation Teacher I
To Attend the Demonstration on the use
Purpose of Travel and receive the CPR Mannequin
Collection (Adult, Child, Infant) from the
Provincial Government of La Union
Provincial Government of La Union &
Activity Organized / Sponsored by
LUSDO
Period Covered
January 15, 2020
(Inclusive of Travel Time)
Please Check Official Business Official Time
Venue / Destination Diego Silang Hall, Provincial Capitol, City
of San Fernando, La Union
(Subject to the usual accounting and auditing rules and
Expenses Covered:
regulations)

Fund Source Local Fund

Recommending Approval: Approved:

ARNULFO N. LIBAO PERPETUA M. ESLAVA, Ph.D.

Head Teacher I School Principal IV
Name and Signature Name and Signature

Date:______________ Date:________________
 LA UNION SCHOOLS DIVISION OFFICE
REGION I
2500, CITY OF SAN FERNANDO, LA UNION
Tel. No. (072) 607-8127 // 242-8127 // 700-4188

Annex B

LOCATOR SLIP
REGION: I
BUREAU / DIVISION / SCHOOL:
DATE OF FILING
NAME
PERMANENT STATION
POSITION/DESIGNATION
PURPOSE

PLEASE CHECK Official Business Official Time

DESTINATION
DATE AND TIME OF EVENT /
TRANSACTION / MEETING
Approved:

___________________________ PERPETUA M. ESLAVA, Ph.D.

Signature of Requesting Official / School Head
Employee

Date: ________________ Date: _______________

CERTIFICATION
This is to certify that the above employee appeared in this Office for the above purpose.

________________________ __________________ __________________

Signature over printed name Position Date

(Note: This portion shall be filled out by Official/Authorized personnel of the Office visited.)
 ITINERARY OF TRAVEL

Name: JUMAR A. BALDREZ Position: __Teacher I_________________________

Official Station: Luna National Vocational High School, Luna, La Union

PURPOSE OF TRAVEL: To Attend the Demonstration on the use and receive the CPR Mannequin
Collection (Adult, Child, Infant) from the Provincial Government of La
Union
Means of
Date Places to be Time Transportation
Expenses Total
visited Departure Arrival Transportation Per diem Amount
01/15/202 LNVHS- San 12:30 01:25 Jeepney 50.00 50.00
0 Fernando City
proper
San Fernando City 01:25 01:30 Tricycle 20.00 20.00
proper- Provincial
Capitol
Provincial Capitol- 03:30 03:35 Tricycle 20.00 20.00
San Fernando City
proper
San Fernando City 03:35 04:45 Jeepney 50.00 50.00
proper- LNVHS

TOTAL 140.00

I certify that (1) I have reviewed the foregoing

Itinerary (2) the travel is necessary to the service (3) the
period covered is reasonable and (4) expenses claimed
are proper.
Prepared by:

JUMAR A. BALDREZ
Teacher I

Recommending Approval:

PERPETUA M. ESLAVA, Ph.D.

School Principal IV

APPROVED:

. DR. MARCIANO U. SORIANO, JR.

Assistant Schools Division Superintendent

THIS FORM SHALL BE ATTACHED TO ALL CLAIMS FOR TRAVELLING EXPENSES

Appendix B
_____DepED_____
(Agency)

ATTY. DONATO D. BALDERAS, JR. LA UNION SCHOOLS DIVISION OFFICE

(Agency Head) (Station)

Schools Division Superintendent _________________

(Position) (Date)

I CERTIFY that I have completed the travel authorized in the Itinerary of Travel
No. dated ___________________ under the conditions
indicated below.
X Strictly in accordance with the approved itinerary

Cut short as explained below. Excess payment in the amount of

P _______ was refunded under OR No. _______

Extended as explained below. Additional Itinerary as submitted

Other deviations as explained below

Explanation or
justifications___________________________________________
_____________________________________________________________________
_____________________________________________________________________

Used Tickets

x Certificate of Appearance

Others __________________
__________________
__________________

Respectfully submitted:

JUMAR A. BALDREZ
Teacher I

Recommending Approval:

PERPETUA M. ESLAVA, Ph.D.

School Principal IV

On evidence and information of which I have knowledge, the travel was actually
undertaken.

Approved:

DR. MARCIANO U. SORIANO, JR.

Assistant Schools Division Superintendent