MEMO28 Forms and Templates COA Circular 2022 004 2
MEMO28 Forms and Templates COA Circular 2022 004 2
MEMO28 Forms and Templates COA Circular 2022 004 2
2022-004
Semi-expendable Property:
Semi-expendable Property
Description : Number:
Entity Name:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life
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SUPPLIER:
INVOICE NO. & DATE (dd-mmm-yyyy):
FUND CODE:
Signature over Printed Name (Property / Supply Custodian) Signature over Printed Name (Recipient/ End-user)
Position/Office Position/Office
Signature :
Portenio M. Mercado
End-User In-charge, SPMO Junkyard
Bennie M. Evangelista
Head, Property Management Section
Date (dd-mmm-yyyy)
COA Circular 2022-004
Semi-
Responsibility
ICS No. expendable Item Description Unit Quantity issued Unit Cost Amount
Center Code
Property No.
Posted by:
I hereby certify to the correctness of the above information.
Signature over Printed Name of Property and/or Supply Custodian Signature over Printed Name of
Designated Accounting Staff
COA Circular 2022-004
For which __(Name of Accountable Officer)_____,_(Official Designation)__,______(Entity Name)_______ is accountable, is having assumed such accountability on __(Date of Assumption)__.
Signature over Printed Name of Inventory Signature over Printed Name of Head of Signature over Printed Name of
Committee Chair and Members Agency/Entity or Authorized Representative COA Representative
COA Circular 2022-004
Stolen Destroyed
Circumstances:
I hereby certify that the item/s and circumstances stated above are true and correct. Noted by:
Signature over Printed Name of the Accountable Officer Signature over Printed Name of the
Immediate Supervisor
Government Issued ID :
ID No. :
Date Issued :
SUBSCRIBED AND SWORN to before me this ______ day of ____________, affiant exhibiting the above
government issued identification card.
Doc. No.
Page No. Notary Public
Book No.
Series of
INVENTORY AND INSPECTION REPORT OF UNSE
As at ____________________________
INVENTORY
Accumulat Accumulat
Date Particulars/ Property Unit Total ed ed Carrying
Qty
Acquired Articles No. Cost Cost Depreciati Impairmen Amount
on t Losses
(1) (2) (3) (4) (5) (6) (7) (8) (9)
181
I HEREBY request inspection and disposition, pursuant to Section 79 of PD 1445, of the property
enumerated above.
INVENTORY
Semi
Accumulated
Date Particulars/ Expandabl Unit Total Carrying
Qty Impairment Remarks
Acquired Articles eProperty Cost Cost Amount
Losses
No.