Appendix 10

OBLIGATION REQUEST AND STATUS

Republic of the Philippines Serial No.:
DEPARTMENT OF LABOR AND EMPLOYMENT Date:
Regional Office No. X Fund:
Monte Carlo Bldg., Phase 1, RER Subdivision
National Highway, Kauswagan, Cagayan de Oro City
Payee Charlton James Busa
Office DOLE X
Address MONTECARLO BLDG. RER PHASE I, KAUSWAGAN NATIONAL HIGHWAY CDOC
Responsibility
Center Particulars MFO/PAP UACS Object Code Amount

To cash advance the travelling expenses

which will be incurred out on official
business

3,474.00

Total 3,474.00
A. Certified: Charges to appropriation/allotment necessary, lawful and B. Certified: Allotment available and obligated for the
under my direct supervision ; and supporting documents purpose/adjustment necessary as indicated above
valid, proper and legal

Signature Signature
Printed Name ATHENEUS A. VASALLO Printed Name AKISA L. GURO
Position TSSD CHIEF Position AO V/ Budget Officer III
Head, Requesting Office/ Authorized Representative Head, Budget Unit/ Authorized Representative

Date Date

C. STATUS OF OBLIGATION
Reference Amount
Balance
ORS/JEV/RCI/ Obligation Not yet Due
Payment (a-b) Due and
Date Particulars RADAI Payable (b)
(a) (c) Demandable
No.
(b-c)
 Appendix 31
Republic of the Philippines Fund:
DEPARTMENT OF LABOR AND EMPLOYMENT
Regional Office No. X
Monte Carlo Bldg., Phase 1, RER Subdivision
National Highway, Kauswagan, Cagayan de Oro City
DV No.:
DISBURSEMENT VOUCHER
Mode of Payment
MDS Check Commercial Check ADA NCAA OTHERS
TIN/Employee No.: ORS/BURS No.:
Payee Charlton James Busa

Address MONTECARLO BLDG. RER PHASE 1 KAUSWAGAN NATIONAL HIGH WAY CDOC
Responsiblity
Particulars MFO/PAP Amount
Center

To cash advance the travelling expenses which will be

incurred out on official business 3,474.00

Amount due 3,474.00

A. Certified:
ATHENEUS A. VASALLO/TSSD CHIEF
PRINTED NAME, DESIGNATION AND SIGNATURE OF SUPERVISOR

B. Accounting Entry:
Account Title Account Code Debit Credit

C. Certified: D. Approved for Payment

Cash Available
Subject to Authority to Debit Account (when
applicable)

Supporting documents complete

Signature Signature

Printed Name LUZ C. GAA Printed Name JOFFREY M. SUYAO

Position REGIONAL ACCOUNTANT Regional Director
Head,Accounting Unit/Authorized Representative Position Agency Head/Authorized Representative

Date Date
E. Receipt of Payment JEV No.
Check/ADA No. Date: Bank Name:
Signature Date: Printed Name: Date

Offical Receipt/Other Documents

 Annex "B"
Republic of the Philippines
DEPARTMENT OF LABOR AND EMPLOYMENT
Regional Office No. X
Monte Carlo Bldg., Phase 1, RER Subdivision
National Highway, Kauswagan, Cagayan de Oro City

CERTIFICATE OF TRAVEL COMPLETED

JOFFREY M. SUYAO DOLE 10

(Agency Head) (Station)

REGIONAL DIRECTOR 5/9/2017

(Designation) (Date)

I HEREBY CERTIFY that I have completed travel authorized in the itinerary of

Travel Order No. dated , 2017 under conditions indicate below.

x Strictly in accordance with approved itinerary

CUT SHORT AS EXPLAINED BELOW. Excess payment of O.R. _______dated _____

Extended as explained below.Additional itinerary was submitted.
Other deviations as explained below.

Explanations as Justifications:

X Boat Tickets
X Bus Tickets
X Certificate of Appearance
Others

Respectfully submitted:

CHARLTON JAMES R. BUSA

LEO III

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

ATHENEUS A. VASALLO
TSSD CHIEF
 Appendix 19
No.:
LIQUIDATION REPORT
Republic of the Philippines Date:
DEPARTMENT OF LABOR AND EMPLOYMENT Responsibility Center:
Regional Office No. X
Monte Carlo Bldg., Phase 1, RER Subdivision

National Highway, Kauswagan, Cagayan de Oro City

Particulars Amount
Expenses Incurred:

To Liquidate cash advance incurred while on official travel to Camiguin dated 2,294.00
August 8-11, 2017 in the amount of …

TOTAL AMOUNT SPENT 2,294.00

AMOUNT FOR CASH ADVANCE 2,294.00
PER DV NO. . DATED:
-
AMOUNT REFUNDED PER OR No. DATED:
AMOUNT TO BE REIMBURSED -
A. Certified Correctness of the B. Certified Purpose of C. Certified supportive documents
above data: travel/cash advance duly complete and proper
accomplished

CHARLTON JAMES BUSA ATHENEUS A. VASALLO LUZ C. GAA

Claimant Immediate Supervisor Head, Accounting Unit JEV No.
 Republic of the Philippines
DEPARTMENT OF LABOR AND EMPLOYMENT
Regional Office No. X
Monte Carlo Bldg.,Phase 1, RER Subdivision,
National Highway, Kauswagan, Cagayan de Oro City

ITINERARY OF TRAVEL
NAME: Charlton James Busa PFO/Unit:
PURPOSE OF TRAVEL:
See attached Travel Orders
TIME
Date Place to be Visited (DESTINATION) Means of Transportation
Departure Arrival
8/9/2017 Regional office to Balingoan 8:00AM 10:00AM Office Vehicle
Balingoan to Benoni Port 10:00am 11:30AM Barge
Terminal Fee
Environmental Fee
Per Diem
8/10/2017 still in camiguin
8/11/2017 Benoni Port to Balingoan 6:00 AM 8:00am Barge
Balingoan to CDO 8:00 AM 12:00NN Office Vehicle
Terminal Fee
Environmental Fee
Per Diem

Grand Total
I CERTIFY THAT (1) I have reviewed foregoing itinerary, (2) the travel is reasonable and (3) the expenses are proper.

Prepared by: Approved by:

Charlton James Busa ATHENEUS A. VASALLO

Printed Name, Designation and Signature of Printed Name, Designation and Signature of Immediate
Officer/Employee Supervisor

ATTY. JOFFREY SUYAO

REGIONAL DIRECTOR
Printed Name, Designation and Signature of Head of
Office
 TSSD

Travel Allowance

170.00
15.00
2.00
800.00
800.00
170.00

15.00
2.00
320.00

2,294.00
) the expenses are proper.

S A. VASALLO
n and Signature of Immediate
pervisor

FFREY SUYAO
AL DIRECTOR
tion and Signature of Head of
Office
 Republic of the Philippines
DEPARTMENT OF LABOR AND EMPLOYMENT
Regional Office No. X
Monte Carlo Bldg.,Phase 1, RER Subdivision,
National Highway, Kauswagan, Cagayan de Oro City

ITINERARY OF TRAVEL
NAME: Charlton James Busa PFO/Unit:
PURPOSE OF TRAVEL:
See attached Travel Orders
TIME
Date Place to be Visited (DESTINATION) Means of Transportation
Departure Arrival
8/16/2017 Regional office to Balingoan 8:00AM 10:00AM Bus
Balingoan to Benoni Port 10:00am 11:30AM Barge
Terminal Fee
Environmental Fee
Per Diem
Benoni Port to Camiguin PFO 12:00nn 12:30NN PUJ
8/17-18/2017 still in camiguin
8/19/2017 Camiguin PFO to Benoni Port 5:30AM 6:00AM PUJ
Benoni Port to Balingoan 6:00 AM 8:00am Barge
Balingoan to CDO 8:00 AM 12:00NN Bus
Terminal Fee
Environmental Fee
Per Diem

TOTAL

Prepared by: Approved by:

Charlton James Busa ATHENEUS A. VASALLO

Printed Name, Designation and Signature of Printed Name, Designation and Signature of Immediate
Officer/Employee Supervisor
 TSSD

Travel Allowance

160.00
170.00
15.00
2.00
800.00
30
1,600.00
30.00
170.00
160.00
15.00
2.00
320.00

3,474.00

S A. VASALLO
n and Signature of Immediate
pervisor
 70
35
32
60
76
19
53
86
108
197
94
50
56
80
51
1067
1091
24
 REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF LABOR AND EMPLOYMENT
Regional office NO. 10
Cagayan De Oro City

PER DIEM PAYROLL TO. NO. 143

CLAIMANT DATE OF TRAVEL AMOUNT

1 APRIL 5-7, 2017 160.00

RD ATTY. JOFFREY M. SUYAO

2 APRIL 5-7, 2017 160.00

OIC-ARD PAHALLA, ESTRELLA

3 ACOSTA, EBBA B.
APRIL 5-7, 2017 160.00

4 CABAÑOG, REMEGIO D.
APRIL 5-7, 2017 160.00

5 APRIL 5-7, 2017 160.00

CANO, PAOLO
6 GAA, LUZ C. APRIL 5-7, 2017 160.00

7 APRIL 5-7, 2017 160.00

GALLEGO, EVELYN

8 APRIL 5-7, 2017 160.00

GURO, AKISA L.
9 LABIAL GLENFORD C.
APRIL 5-7, 2017 160.00

10 MAHUSAY, ROLANDO M. APRIL 5-7, 2017 160.00

11 NATIVIDAD, JOSE ERROL A. APRIL 5-7, 2017 160.00

12 PULVERA, LUCILA S. APRIL 5-7, 2017 160.00

13 RODRIGO, LEONARDO G. APRIL 5-7, 2017 160.00

14 SALAPANG, YORADYL DAWN APRIL 5-7, 2017 160.00

15 SALINAS, BERNIE BOY T. APRIL 5-7, 2017 160.00

16 VALMORES, RAUL L. APRIL 5-7, 2017 160.00

17 VASALLO, ATHENEUS A. APRIL 5-7, 2017 160.00

18 JUMAWAN, ELGENE APRIL 5-7, 2017 160.00

19 PUGOY, JONATHAN APRIL 5-7, 2017 160.00

20 ECHAVEZ TIMOTHY APRIL 5-7, 2017 160.00

21 ABAGA, MICHAEL APRIL 5-7, 2017 160.00

GRAND TOTAL 3,360.00

MENT

NO. 143

SIGNATURE
 CELLCARDS ISSUANCES

FOR THE MONTH OF MAY 2017

CLAIMANT AMOUNT
1 ACOSTA, EBBA B. 1,000.00
2 ALVAREZ, SHIRLEY 200.00
3 CABAÑOG, REMEGIO 1,000.00
4 DABLIO, MILDRED 200.00
5 JUMAWAN, ELGENE 200.00
6 NATIVIDAD, JOSE ERROL 1,000.00
7 PAHALLA, ESTRELLA U. 1,800.00
8 PULVERA, LUCILA 600.00
9 RODRIGO, LEONARDO 1,000.00
10 SUYAO, ATTY. JOFFREY M. 2,300.00
11 TOLEDO, EMMANUEL 1,000.00
12 VALMORES, RAUL 1,000.00
13 VASALLO, ATHENEUS 1,000.00

12,300.00
 LIQUIDATION REPORT
Republic of the Philippines
DEPARTMENT OF LABOR AND EMPLOYMENT
Regional Office No. X
Monte Carlo Bldg., Phase 1, RER Subdivision

National Highway, Kauswagan, Cagayan De oro City

List of Designated SEADO's who will received a monthly cellphone card worth P200.00/month.

MONTH
CLAIMANT April 2017
BUKIDNON PFO 200.00
1 Reyna L. Tagailo 200.00
2 Archibald S. Batica

Camiguin PFO
3 Jovelyn V. Perez 200.00
4 Rene R. Valenzuela 200.00

Eastern Mis. Or PFO

5 Monadette N. Balanay 200.00
6 Ma. Theresa L. Trozo 200.00

Lanao del Norte PFO

7 Annie Raidah M. Mua 200.00
8 Eulita Y. Escalante 200.00

Misamis Occidental PFO

9 Jasmin l. Vicente 200.00
10 Jose G. Robles 200.00

Western Mis. Or. PFO

11 Mary Joyce A. Harnaiz 200.00
12 Aloha B. Jaudian 200.00
13 Lolita Z. Usaraga 200.00

Grand Total 2,600.00

Certified By:

Luz C. Gaa
Regional Accountant
MONTH TOTAL
May 2017
200.00 400.00
200.00 400.00

200.00 400.00
200.00 400.00

200.00 400.00
200.00 400.00

200.00 400.00
200.00 400.00

200.00 400.00
200.00 400.00

200.00 400.00
200.00 400.00
200.00 400.00

2,600.00 5,200.00
 Luz C. Gaa
Regional Accountant