REIMBURSEMENT FOR EXTRA FARE

Name: Alvarez, Aljohn P.

Territory: Taguig/ Makati/ Pateros. Pasay
District: SOUTH LUZON/SOUTH GMA
Period Covered: Jan 20-23, 2015

Date of Trip
19-Jan

Destination

Day
Monday

From

To

Residence

Imus Bayan

Imus Bayan

Taft, Pasay

Taft, Pasay

Cubao

Cubao

Marikina Valley Hospital

Marikina Valley Hospital

St. Patrick Hospital

St. Patrick Hospital

Good Shepherd Polyclinic

Good Shepherd Polyclinic

St. Anthony Hospital

St. Anthony Hospital

Terminal

Terminal

Cubao

Cubao

Taft, Pasay

Taft, Pasay

Imus Bayan

Imus Bayan

Residence

Prepared by:
___________________________________________
(Signature over Printed Name)

FOR EXTRA FARE EXPENSES

SUMMARY:
Fixed Transport
Actual Total Fare For Reimbursement
Allowance
19-Jan
240.00
266.00
26.00
20-Jan
21-Jan
22-Jan
23-Jan
24-Jan
TOTAL:
26.00

Date

Mode of
Transpo

To

Hospital

Fare

Total

TRICYLE

45.00

45.00

BUS

25.00

25.00

MRT

24.00

24.00

FX

25.00

25.00

pital

JEEP

7.00

7.00

d Polyclinic

JEEP

7.00

7.00

JEEP

7.00

7.00

TRICYCLE

7.00

7.00

FX

25.00

25.00

MRT

24.00

24.00

BUS

25.00

25.00

TRICYCLE

45.00

45.00

spital

0.00
Approved by:
_________________________________________________
Immediate Superior

FIELDMAN'S EXP
NAME: Alvarez, Aljohn P.

PER

FROM
PLEASE CHECK CATEGORY OF EXPENSES:

MARKETING EXPENSES

(ACTIVITY EXPENSES THAT SHOULD BE APPROVED BY PRODUCT MANAGERS)

OPERATIONAL EXPENSES

DATE

DAY

(FIELD EXPENSES CHARGE TO PCHC BUDGET)

MOVEMENT
PLACE(S) COVERED

27-Jan Tuesday

San Juan de Dios Hospital, Pasay City

27-Jan Tuesday

Manila Adventist Medical Center

1-Feb Sunday

Cellphone Load

Xerox

FAX

PARKING & TOLL

FEES

TOTAL EXPENSES:

ACCOUNTING/ BUDGET:

I CERTIFY THAT THE FACTS AND FIGURES CONTAINED IN THIS REPORT ARE TRUE AND CORRECT AND ALL THE EXPENSES REPORTED HEREIN
WERE INCURRED BY ME IN THE OFFICIAL PERFORMANCE OF MY DUTIES AND RESPONSIBILITIES TO THE COMPANY.

SUPERVISOR'S NAME & SIGNATURE :

GUALBERTO MA. S. GUARDA
(IMPORTANT: THE REPORT WILL NOT BE PROCESSED WITHOUT THE SIGNATURE OF THE SUPERVISOR)

REPORTED BY: A

AN'S EXPENSE REPORT

PERIOD COVERED:

TERRITORY

EXPENSES

FROM Jan 19 - Jan 30

Taguig/ Makati/ Pateros/ Pasay

PAGE NO.

OFC SUPPLIES

POSTAGE

INTERNET
RENTALS

OTHERS (Hosp ID)

SUMMARY OF APPROVED EXPENSES

TOTAL EXP

(For Accounting Use Only)

1,000.00

1,000.00

500.00

500.00

GASOLINE

300.00

FARE

300.00

CODE

LODGING

MEALS & TRANPORT

REPAIR & MAINTENANCE

OFFICE SUPPLIES

AD & PROMOTIONS

TELEPHONE &

POSTAGE

OTHERS

AMOUNT

GRAND TOTAL

Php

Fieldman's explanation of OTHER EXPENSES

0
AUDITING:

ORTED BY: Alvarez, Aljohn P.

1800

1,800.00

REQUEST FOR ADDITIONAL OUTS

PASCUAL LABORA
Name of Employee
Ritz Neilven Dizon

Date of Trip

Destination

Person / Outlet To Visit

20-Jan

Marikina City

Naga City

21-Jan

Naga City

(encode hospitals/territoria

22-Jan

Legaspi

(encode hospitals/territoria

23-Jan

Naga City

(encode hospitals/territoria

26-Jan

Daet

(encode hospitals/territoria

27-Jan

Lucena

(encode hospitals/territoria

28-Jan

Lucena

(encode hospitals/territoria

29-Jan

Naga City

(encode hospitals/territoria

30-Jan

Naga City

(encode hospitals/territoria

Date of Request
Feb. 2

Requested By

Approved by

Ritz Neilven Dizon

DBM

RSM

REQUEST FOR ADDITIONAL OUT

PASCUAL LABORATO
Name of Employee

Date of Trip

Destination

Person / Outlet To Visit

Date of Request

Requested By

Approved by

DBM

RSM

DITIONAL OUTSTATION ALLOWANCE (LODGING)

CUAL LABORATORIES, INC.
SBU

Designation

PCHC

Territory
Bicol/Quezon

Lodging
Person / Outlet To Visit

No. of Nights

Allowance

Naga City

350.00

350.00

ncode hospitals/territorials)

350.00

350.00

ncode hospitals/territorials)

350.00

350.00

ncode hospitals/territorials)

350.00

350.00

ncode hospitals/territorials)

350.00

350.00

ncode hospitals/territorials)

350.00

350.00

ncode hospitals/territorials)

350.00

350.00

ncode hospitals/territorials)

350.00

350.00

ncode hospitals/territorials)

350.00

350.00

TOTAL

Amount

3,150.00 Total
3,150.00

Prcocessed By

Checked By

DITIONAL OUTSTATION ALLOWANCE (LODGING)

UAL LABORATORIES, INC.
SBU

Designation

Territory

PCHC
Lodging
Person / Outlet To Visit

No. of Nights

Allowance

Amount

TOTAL

Prcocessed By

Total

Checked By

RITZ NEILVEN DIZON

TERRITORY: BICOL/QUEZON
#
1
2
3
4
5
6
7
8
9
10

HOSPITAL

ROBERT CHARLES MAGBUHOS

TERRITORY: BATANGAS/LAGUNA
#
1
2
3
4
5
6
7
8
9
10

HOSPITAL

SONJA BARIA
TERRITORY: PARANAQUE/LAS PINAS/MUNTINLU
#
1
2
3
4
5
6
7
8
9
10

HOSPITAL

ARLENE CALINAO
TERRITORY: MARIKINA/RIZAL UPTOWNS/P
#
1
2
3
4
5
6

HOSPITAL

7
8
9
10

RITZ NEILVEN DIZON

TERRITORY: BICOL/QUEZON
ADDRESS

ROBERT CHARLES MAGBUHOS

TERRITORY: BATANGAS/LAGUNA
ADDRESS

SONJA BARIA
TERRITORY: PARANAQUE/LAS PINAS/MUNTINLUPA/CAVITE
ADDRESS

ARLENE CALINAO
TERRITORY: MARIKINA/RIZAL UPTOWNS/PASIG
ADDRESS

AMOUNT
200.00

DATE
24-Jan-15

AMOUNT
200.00

DATE
24-Jan-15

AMOUNT
200.00

DATE
24-Jan-15

AMOUNT
200.00

DATE
24-Jan-15

CRISPIN
TERRITORY: TON
OR#
1234567890

HOSPITAL

1
2
3
4
5
6
7
8
9
10

LEVIN VE
TERRITORY: SAN JUAN
OR#
1234567890

HOSPITAL

1
2
3
4
5
6
7
8
9
10

ALJOH
TERRITORY: MAKATI
OR#
1234567890

OR#
1234567890

HOSPITAL

1 San Juan De Dios Hospital

2 Manila Adventist Medical Center
3
4
5
6
7
8
9
10

CRISPINO PASUBILLO
TERRITORY: TONDO/BINONDO/MANILA
ADDRESS

LEVIN VERGEL LIMJOCO

TERRITORY: SAN JUAN/MANDALUYONG/STA. MESA
ADDRESS

ALJOHN ALVAREZ
TERRITORY: MAKATI/TAGUIG/PATEROS/PASAY
ADDRESS
Pasay Citry
1975 Donada st. Pasay City

AMOUNT
200.00

DATE
24-Jan-15

AMOUNT
200.00

DATE
24-Jan-15

AMOUNT
1000.00
500

DATE
27-Jan-15
27-Jan-15

OR#
1234567890

OR#
1234567890

OR#
424
82823

PASCUAL CONSUMER HEALTHCARE CORP.

9TH FLOOR ETON CYBERPOD BLDG, EDSA COR. QUEZON AVE. QUEZON CITY

Acknowledgement Receipt

This is to acknowledge receipt of the following:

________________
Signature/ Designation

Contact no:

__________________
Date

_________________

PASCUAL CONSUMER HEALTHCARE CORP.

9TH FLOOR ETON CYBERPOD BLDG, EDSA COR. QUEZON AVE. QUEZON CITY

Acknowledgement Receipt
This is to acknowledge receipt of the following:

______________
Signature/ Designation

Contact no:

__________________

__________________
Date

NAME

DATE OF TRIP

Date of Request

NAME

DESTINATION

Signature:

DATE OF TRIP

Date of Request

DESTINATION

Signature:

REIMBURSEMENT FOR FARE / GASOLINE EXPENSE

DESIGNATION

TBM

PERSON / OUTLET TO VISIT

TERRITORY

(FOR GASOLINE

NO. OF DAYS

BEG. KM

END KM

TOTAL
9 Liters consumed (Total KM travelled/9)
Average Cost per liter/ Fare Expense
TOTAL
Less: Daily Transpo Allowance
Total Amount Due
Approved by
DBM

Processed by
RSM

REIMBURSEMENT FOR FARE / GASOLINE EXPENSE

DESIGNATION

TERRITORY

(FOR GASOLINE
PERSON / OUTLET TO VISIT

NO. OF DAYS

BEG. KM

END KM

TOTAL
Liters consumed (Total KM travelled/9)
Average Cost per liter/ Fare Expense
TOTAL
Less: Daily Transpo Allowance
Total Amount Due
Approved by
DBM

Processed by
RSM

GASOLINE EXPENSE

FOR FARE
REIMBURSEMENT

(FOR GASOLINE)

Total KM Travelled

GASOLINE EXPENSE

Checked by

Amount

FOR FARE
REIMBURSEMENT

(FOR GASOLINE)

Total KM Travelled

Checked by

Amount

Date:
CRRF No.:

CAR REPAIR REQUISITION FORM (CRRF)

ADMINISTRATION DEPARTMENT
FOR REQUESTING CAR ASSIGNEE USE ONLY
REQUESTING UNIT/SECTION/DEPARTMENT/SBU:
CAR DETAILS:
PLATE NO.
MODEL:

MAKE TYPE:
KM Reading:

REQUESTED SERVICE CLASSIFICATION:

Car Repair
Car Maintenance
Others (specify)
JOB ORDER DESCRIPTION:

Prepared by/Date:

Checked by/Date:

Approved by/Date:

Princes Fernando
Car Assignee

Supervisor/DBM

Depa

FOR ADMINISTRATION DEPARTMENT'S USE ONLY

COST AND CAR REPAIRS & MAINTENANCE SCOPE OF WORKS

AMOUNT

Total Cost
Remaining Budget:
Over/Under
Remarks:

Evaluated by/Date:

Checked & Recommended by/Date:

Admin Staff/Specialist

Admin Manager

Approved by/Date:

SITION FORM (CRRF)

ON DEPARTMENT

AR ASSIGNEE USE ONLY

Department/Division Head

DEPARTMENT'S USE ONLY

ACS/CASA

VP-Admin