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This document is a certification form for expenses not requiring receipts from the KALAHI-CIDSS:NCDDP program in Mayorga Leyte. The form includes spaces for the claimant's name, barangay, transportation expenses including date and particulars, total amount, purpose of expenses, and certifications by the claimant and BDC-TWG chair that the expenses were necessary and goods/services were acquired from non-receipt issuing parties. Certifiers acknowledge willful falsification is punishable by law.

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John Rey Ayo
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46 views1 page

Cenrr

This document is a certification form for expenses not requiring receipts from the KALAHI-CIDSS:NCDDP program in Mayorga Leyte. The form includes spaces for the claimant's name, barangay, transportation expenses including date and particulars, total amount, purpose of expenses, and certifications by the claimant and BDC-TWG chair that the expenses were necessary and goods/services were acquired from non-receipt issuing parties. Certifiers acknowledge willful falsification is punishable by law.

Uploaded by

John Rey Ayo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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Annex A Annex A

KALAHI-CIDSS:NCDDP KALAHI-CIDSS:NCDDP
MAYORGA LEYTE MAYORGA LEYTE
BARANGAY_____________ BARANGAY_____________
CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS
Pursuant to COA Circular No. 2017-001 dated June 19, 2017 Pursuant to COA Circular No. 2017-001 dated June 19, 2017

Name : Name :
Brgy: Brgy:
TRANSPORTATION TOTAL AMOUNT TRANSPORTATION TOTAL AMOUNT
Date Particulars Date Particulars

TOTAL - TOTAL -
Purpose: Purpose:

I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose, that above goods and I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose, that above goods and
services were acquired from parties not issuing receipts and that I am fully aware that wilful falsification of statements is punishable services were acquired from parties not issuing receipts and that I am fully aware that wilful falsification of statements is punishable
by law. by law.
Certified Correct: Noted By: Certified Correct: Noted By:

Signature Signature

Printed Name: Printed Name:


Claimant BDC-TWG Chair Claimant BDC-TWG Chair

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