REQUISITION AND ISSUANCE SLIP

CIVIL SERVICE COMMISSION

Regional Office No. I San Fernando City, la Union DIVISION OFFICE

CSC LUFO REQUISITION

Responsibility Center Code

RIS NO. SAI NO.

ISSUANCE
QTY QTY REMARKS

STOCK NO.

UNIT

DESCRIPTION

WATER WATER DELIVERY

OFFICE SUPPLIES

PURPOSE : CABLE SUBSCRIPTION

Requested by:
Signature Printed Name Designation Date
VIOLETA NIPAL-MENDOZA

Approved by:

Issued by:

Received by:

NELSON G. SARMIENTO
Acting Director IV

Director II

PURCHASE ORDER CIVIL SERVICE COMMISSION Regional Office No. I San Fernando City, La Union SUPPLIER ADDRESS TIN : COVELANDIA DU LABRADOR BEACH RESORT : : P.O. NO. DATE: MODE OF PROC.

GENTLEMEN: Please furnish this Office the following articles subject to the terms and conditions contained therein. Place of Delivery: CSC RO1 Delivery Term: FOB Destination Date of Delivery: Payment Term: N/30 STOCK UNIT UNIT ARTICLE QTY AMOUNT NO. COST 982,279.00 MEALS AND SNACKS ACCOMMODATION
LESS: INITIAL PAYMENT

363,800.00 618,479.00

Total IN CASE OF FAILURE TO MAKE THE FULL DELIVERY WITHIN THE TIME SPECIFIED ABOVE, A PENALTY OF ONE-TENTH (1/10) OF ONE PERCENT FOR EVERY DAY OF DELAY SHALL BE IMPOSED. CONFORME: Very truly yours,

1,964,558.00

(sign over Printed Name) (Date)

NELSON G. SARMIENTO Acting Director IV

FUNDS AVAILABLE: IMELDA F. SUYAT Accountant III ALOBS NO. AMOUNT:

INSPECTION AND ACCEPTANCE REPORT CIVIL SERVICE COMMISISON Regional Office No. I San Fernando City, la Union SUPPLIER P.O. NO. 2012-08-010 Requisitioning Office/Dep't. STOCK NO. UNIT units NT CENTRAL TRADING INVOICE NO. LUFO ] DESCRIPTION FLATFORM LADDER 7 FEET QTY 1 IAR NO. 8 DATE: 8/13/2012

DATE:

INSPECTION DATE INSPECTED: X INSPECTED, VERIFIED AND FOUND IN ORDER AS TO QUANTITY AND SPECS x COMPLETE PARTIAL (pls. Specify quantity)

MA. ROSETTE U. RONDUEN Inspection Officer

Gerald Erwin P. Abaya Administrative Officer III

ACKNOWLEDGMENT RECEIPT FOR EQUIPMENT CIVIL SERVICE COMMISSION Regional Office No. I San Fernando City, La Union

Quantity 1 unit

Unit

Descriptions

Property No.

Received by:

Received from:

CECILIA R. BARENG Chief Personnel Specialist Date: January 13, 2011

ATTY. ENGELBERT ANTHONY D. UNITE Director IV Date: January 13, 2011

Amount

Republic of the Philippines

CIVIL SERVICE COMMISSION

Regional Office No. I San Fernando City, La Union

DISBURSEMENT VOUCHER
Mode of Payment Payee Address
MDS Check Commercial Check ADA Others

TIN/Employee No.:

OR/BUR No. :

COVELANDIA DU LABRADOR BEACH RESORT

LABRADOR, PANGASINAN EXPLANATION

Office/Unit/Project

Responsibility Center Code AMOUNT

TO PAYMENT OF MEALS AND SNACKS AND ACCOMMODATION OF PARTICIPANTS TO THE 18 TH ANNUAL CONVENTION OF HUMAN RESOURCE MANAGEMENT PRACTITIONERS ON MARCH 5-7, 2013 GROSS AMOUNT 877,034.82 552,213.39 LESS: Pp 727,600.00 x 50 % downpayment SUB-TOTAL LESS: 2% EWT 11,044.27 5 % FT 27,610.67 NET AMOUNT DUE 982,279.00 363,800.00 618,479.00

579,824.06

38,654.94 579,824.06

A. Certified:

Cash available Subject to Authority to Debit Account [when applicable]

B.

Approved for payment:

FIVE HUNDRED SEVENTY NINE THOUSAND EIGHT

Signature Printed Name Position Date:

Supporting documents complete

HUNDRED TWENTY FOUR PESOS 7 6/100

579,824.06

IMELDA F. SUYAT Accountant III

Signature Printed Name Position Date:

NELSON G. SARMIENTO Acting Director IV

C.

Received Payment:
Date: Date: Bank Name Printed Name

JEV. NO.

Check/ ADA No. Signature

Date

Official Receipt/Other Documents

Collection Check Disbursement Cash Disbursement Others

ACCOUNTING ENTRIES Responsibility Center AMOUNT Account and Explanation P DEBIT CREDIT

982,279.00 11,044.27 TOTAL 982,279.00 11,044.27

Republic of the Philippines

CIVIL SERVICE COMMISSION

Regional Office No. I San Fernando City, La Union No.

OBLIGATION REQUEST
Payee
Office

COVELANDIA DU LABRADOR BEACH RESORT

Address

SAN FERNANDO CITY, LA UNION

Responsibillity Center

PARTICULARS

P.P.A.

Account Code

Amount

TO PAYMENT OF MEALS AND SNACKS AND ACCOMMODATION OF PARTICIPANTS TO THE 18 TH ANNUAL CONVENTION OF HUMAN RESOURCE MANAGEMENT PRACTITIONERS ON MARCH

579,824.06

Total A. ] Certified: Signature Printed Name Position Date: Charges to appropriation/allotments necessary, lawful and under my direct supervision Supporting documents valid, proper and legal B.] Certified: Allotment available and obligated for the purpose as indicated above.

579,824.06 -

Signature

CECILIA R. BARENG Chief Personnel Specialist-MSD

Printed Name Position Date:

FEBE C. MOLINA Administrative Officer V

Republic of the Philippines

CIVIL SERVICE COMMISSION

Regional Office No. I San Fernando City, La Union

BUDGET UTILIZATION REQUEST

Payee

No.

COVELANDIA DU LABRADOR BEACH RESORT

Office

Address

LABRADOR, PANGASINAN
Account Code Amount

Responsibillity Center

PARTICULARS
TO PAYMENT OF MEALS AND SNACKS AND ACCOMMODATION OF PARTICIPANTS TO THE 18 TH ANNUAL CONVENTION OF HUMAN RESOURCE MANAGEMENT PRACTITIONERS ON MARCH 5-7, 2013

618,479.00

Total A. ] Certified: Signature Printed Name Position Date: Charges to budget necessary, lawful and under my direct supervision Supporting documents valid, proper and legal. B.] Certified:

618,479.00

Budget available and earmarked/utilized for the purpose as indicated above.

Signature Printed Name Position Date:

CECILIA R. BARENG Chief Personnel Specialist-MSD

FEBE C. MOLINA Administrative Officer V

Republika ng Pilipinas Kagawaran ng Pananalapi

Kawanihan ng Rentas Internas

1 For the Period From Part I 2 TIN 4

Certificate of Final Tax Withheld At Source

To 3 5 TIN

BIR Form No.

2306
13 0013

September 2005 (ENCS)

(MM/DD/YY) Income Recipient/Payee Information

03

01 13

(MM/DD/YY) Withholding Agent/Payor Information

03

31

0000

000

476

710

Payee's Name (For Non-Individuals )

Payor's Name (For Non- Individuals)

COVELANDIA DU LABRADOR BEACH RESORT

6 Payee's Name (Last Name, First Name, Middle Name) For Individuals 7

CIVIL SERVICE COMMISSION REGION 1

Payor's Name (Last Name, First Name, Middle Name) For Individuals

Registered Address

Registered Address

QUEZON AVE. SAN FERNANDO CITY LA UNION

8A Zip Code 10A Zip Code 9A Zip Code 10B ICR No. (For Alien Income Recipient Only)

2500

10

Foreign Address

Part II

Details of Income Payment and Tax Withheld (Attach additional sheet if necessary) ATC Amount of Payment 618,479.00 Tax Withheld 27,610.67

Nature of Income Payment TO PAYMENT OF MEALS AND SNACKS AND ACCOMMODATION OF PARTICIPANTS TO THE 18 TH

Total
We declare, under the penalties of perjury, that this certificate has been made in good faith, verified by us, and to the best of our knowledge and belief, is true and correct pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof. Acting Director IV NELSON G. SARMIENTO Payor/Payor's Authorized Representative/Accredited Tax Agent TIN of Signatory Title/Position of Signatory Signature Over Printed Name Tax Agent Accreditation No./Attorney's Roll No. (if applicable) CONFORME: Payee/Payee's Authorized Representative/Accredited Tax Agent Signature Over Printed Name Tax Agent Accreditation No./Attorney's Roll No. (if applicable) TIN of Signatory Title/Position of Signatory Date Signed Date of Issuance Date of Expiry

Date Signed

Date of Issuance

Date of Expiry

To be accomplished for Value-Added Tax/Percentage Tax Withholding (substituted filing)

I declare, under the penalties of perjury, that the information herein stated are reported under BIR Form No. 1600 which have been filed with the Bureau of Internal Revenue. I declare under the penalties of perjury that I am qualified under substituted filing of Percentage Tax/Value Added Tax Returns (BIR Form 2551M/2550M/Q), since I have only one payor from whom I earn my income; that, in accordance with RR 14-2003, I have availed of the Optional Registration under the 3% Final Percentage Tax Wthholding/10% Final VAT Withholding in lieu of the 3% Percentage Tax/10% VAT in order to be entitled to the privileges accorded by the Substituted Percentage Tax Return/Substituted VAT Return System prescribed in the aforesaid Regulations; that, this Declaration is sufficient authority of the withholding agent to withhold 3% Final Percentage Tax/10% Final VAT from my sale of goods and/or services. Payee/Payee's Authorized Representative/Accredited Tax Agent Signature Over Printed Name Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Date of Issuance Title/Position of Signatory

Payor/Payor's Authorized Representative/Accredited Tax Agent Signature Over Printed Name TIN of Signatory Title/Position of Signatory

Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Date of Issuance Date of Expiry

TIN of Signatory Date of Expiry

BIR Form No. Republika ng Pilipinas Kagawaran ng Pananalapi

Certificate of Creditable
13
(MM/DD/YY) To Payee Information

Kawanihan ng Rentas Internas

1 For the Period From Part I 2 Taxpayer Identification Number 3 4 5 Payee's Name Registered Address Foreign Address Payor Information 6 Taxpayer Identification Number 7 8 Payor's Name Registered Address

2307

September 2005 (ENCS)

03

01

03

31

13
(MM/DD/YY)

000
COVELANDIA DU LABRADOR BEACH RESORT
(Last Name, First Name, Middle Name for Individuals) (Registered Name for Non-Individuals) 4A Zip Code 5A Zip Code

000

476

710

0013

CIVIL SERVICE COMMISION REGION I QUEZON AVE. SAN FERNANDO CITY LA UNION
(Last Name, First Name, Middle Name for Individuals) (Registered Name for Non-Individuals) 8A Zip Code

2500

PART II Income Payments Subject to Expanded Withholding Tax TO PAYMENT OF MEALS AND SNACKS AND ACCOMMODATION OF

Details of Monthly Income Payments and Tax Withheld for the Quarter ATC AMOUNT OF INCOME PAYMENTS 1st Month of the Quarter 2nd Month of the Quarter 618,479.00 3rd Month of the Quarter 618,479.00 Total Tax Withheld For the Quarter 11,044.27

Total
Money Payments Subject to Withholding of Business Tax (Government & Private)

618,479.00

618,479.00

11,044.27

Total pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof. Payor/Payor's Authorized Representative/Accredited Tax Agent (Signature Over Printed Name) Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Conforme: Payee/Payee's Authorized Representative/Accredited Tax Agent (Signature Over Printed Name) Tax Agent Accreditation No./Attorney's Roll No. (if applicable) TIN of Signatory Date of Issuance

We declare, under the penalties of perjury, that this certificate has been made in good faith, verified by me, and to the best of my knowledge and belief, is true and correct,

NELSON G. SARMIENTO

Acting Director IV
TIN of Signatory Title/Position of Signatory

Date of Expiry

Title/Position of Signatory

Date Signed

Date of Issuance

Date of Expiry