Travel Format
Travel Format
Travel Format
Total 3,600.00
A. Certified B Certified
Charges to appropriation/allotment necessary, lawful Allotment
B. available and obligated for the
and under my direct supervision purpose as indicated above
Supporting documents valid, proper and legal.
Signature Signature
Printed name ANITA W. ADRIANO Printed Name RINA G. MALLARI
Chief, Finance and Administrative Division Budget Officer III
Position Position
Head, Requesting Office/ Authorized Representative
Date Date
Total 3,600.00
Certified B Certified
A.
Charges to appropriation/allotment necessary, lawful Allotment
B. available and obligated for the
and under my direct supervision purpose as indicated above
Supporting documents valid, proper and legal.
Signature Signature
Printed name ANITA W. ADRIANO Printed Name RINA G. MALLARI
Chief, Finance and Administrative Division Budget Officer III
Position Position
Head, Requesting Office/ Authorized Representative
Date Date
Republic of the Phillippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
Region III, Government Center, Maimpis, City of San Fernando, Pampanga
OBLIGATION REQUEST No.
Payee AIRA MAY T. BALANCIO
Office DILG REGIONAL OFFICE III
Address
Responsibility Account
Center Particulars P.P.A. Code Amount
To reimburse payment of travelling expenses incurred while on
official travel for the period of September 22, November 4-6,
November 10-13, November 17-21, and November 30-December
1, 2014 as per supporting papers hereto attached in the amount
of …..….
Total -
A. Certified B Certified
Charges to appropriation/allotment necessary, lawful Allotment
B. available and obligated for the
and under my direct supervision purpose as indicated above
Supporting documents valid, proper and legal.
Signature Signature
Printed name ANITA W. ADRIANO Printed Name RINA G. MALLARI
Chief, Finance and Administrative Division Budget Officer III
Position Position
Head, Requesting Office/ Authorized Representative
Date Date
DEPARTMENT OF INTERIOR AND LOCAL GOVERNMENT Fund Cluster :
Entity Name
Date :
DISBURSEMENT VOUCHER DV No. :
Responsibility
Particulars MFO/PAP Amount
Center
500.00
To reimburse payment of travelling expenses incurred while
on official travel for the period of JULY,2022Sas per
supporting papers hereto attached in the amount of ….
NAME Of MLGOO
MLGOO
Printed Name, Designation and Signature of Supervisor
B. Accounting Entry:
Account Title UACS Code Debit Credit
COMMUNICATION 5020101000 500
Signature Signature
Printed
Printed Name
Name LENOR CANDICE U. DE GUZMAN ARMI V. BACTAD, CESO V
ADAS II Provincial Director
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date Date
EXPLANATION AMOUNT
To reimburse payment of travelling expenses incurred while on official travel for the period of
September 22, November 4-6, November 10-13, November 17-21 and November 30-
December 1, 2014 as per supporting papers hereto attached in the amount of …..…. 3,600.00
EXPLANATION AMOUNT
To reimburse payment of travelling expenses incurred while on official travel for the period of
September 22, November 4-6, November 10-13, November 17-21 and November 30-
December 1, 2014 as per supporting papers hereto attached in the amount of …..….
3,600.00
EXPLANATION AMOUNT
To reimburse payment of travelling expenses incurred while on official travel for the period of
July 12, 16, 19, Sept. 04, 06, 11, 2012 as per supporting papers hereto attached in the 2,400.00
amount of ….
EXPLANATION AMOUNT
To reimburse payment of travelling expenses incurred while on official travel for the period of
Aug. 23, 24, 29, 30, 31, Sept. 13, 14, 25, 27, 2012 as per supporting papers hereto attached 2,400.00
in the amount of ….
ITINERARY OF TRAVEL
Name : JUAN DELA CRUZ Date:
Station: DILG TARLAC Position: CONTACT TRACER
Purpose of Travel:
See attached Regional Order/Travel Order
TIME MEANS OF ALLOWANCE EXPENSE
DATE STATION DEPARTURE ARRIVAL TRANSPOR- TRANSPOR- PER OTHERS TOTAL
TATION TATION DIEM
TOTAL 500.00
Prepared by:
I certify that : (1) have reviewed the foregoing itinerary,
(2) the travel is necessary to the service, (3) the period
covered is reasonable and (4) the expenses claimed JUAN DELA CRUZ
are proper. Signature over Printed Name
Approved by:
NAME OF MLGOO
Signature over Printed Name
Immediate Supervisor ARMI V. BACTAD, CESO V
Signature over Printed Name
Ageny Head/Authorized Representative
Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
Zamora Street, San Roque, Tarlac City, Tarlac
Date
This is to certify that I have completed the travel authorized in the itinerary of travel dated
Explanations or Justifications :
Respectfully submitted:
On evidence, information of which I have knowledge, the travel was completely undertaken.
Purpose of Travel:
Please see attached approved OB Slip
Activities (Enumerate)
1
2
3
4
5
6
7
8
9
10
Issues/Problems encountered
1
2
3
4
5
Comments/ Recommendations:
1
2
3
4
5