OBLIGATION REQUEST AND STATUS
DEPARTMENT OF AGRARIAN REFORM No. : ________________
SARANGANI PROVINCE Date : ________________
Agency Fund : ________________
Payee PABLITO M. OMAMALIN JR
Office DARPO SARANGANI PROVINCE
Address GENERAL SANTOS CITY
Responsibility UACS Code/
Center
Particulars MFO/PAP Expenditure Amount
4,750.00
Payment of travelling
expenses
Total 4,750.00
Certified: Charges to appropriation/ allotment necessary, Certified: Allotment available and obligated for the
A. lawful and under my direct supervision; and supporting B. purpose/adjustment necessary as indicated above
documents valid, proper and legal
Signature : Signature :
Printed Name : CENON S. ORIGINAL, CESO VI Printed Name : SHENNA H. GELLANGARIN
Position : OIC-PARPO II Position : Acting Budget Officer II
Head Requesting Office/
Authorized Representative Head, Budget Unit/ Authorized
Representative
Date : ___________________________ Date ___________________________
C: STATUS OF OBLIGATION
Reference Amount Due and
Date Particulars ORS/JEV/RCI/RADAI No. Obligation Payment Not Yet Due Demandab
le
Fund Cluster:
DISBURSEMENT VOUCHER
Entity Name Date:
DV No:
DISBURSEMENT VOUCHER
Mode of
Payment MDS Check Commercial Check ADA Others (Please specify)
Payee PABLITO M. OMAMALIN JR TIN/Employee No.: ORS/BURS No.:
Address DARPO SARANGANI PROVINCE
Responsibility
Particulars MFO/PAP Amount
Center
Representing Reimbursement of travelling expenses and per diems
incurred while on official travel outside the official station as per 4,750.00
supporting papers hereto attached in the total amount of
……………….
4,750.00
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.
ATTY. KAY P. AVILES
ATTY. V/CHIEF LEGAL
B. Accounting Entry:
Account Title UACS Code Debit Credit
C. Certified: D. Approved for Payment
Cash available
Subject to Authority to Debit Account (when applicable)
Supporting document complete and amount claimed
proper
Signature Signature
Printer
Printer Name
Name MARK ANTHONY C. DELA TORRE, CPA CENON S. ORIGINAL, CESO VI
ACCOUNTANT II OIC-PARPO II
Position Position
Head Accounting Unit/Authorized Representative Agency Head/ Authorized Representative
Date Date
JEV No.
E. Receipt of Payment
Date: Bank Name & Account Number :
Check/ ADA
No. :
Date: Printed Name: Date
Signature :
Official Receipt No. & Date/Other Documents
ITINERARY OF TRAVEL
Entity Name : DAR ,
Fund Cluster : No.:
Name : PABLITO M. OMAMALIN JR Date of Travel : MARCH 14-15, 2022
Position : ARPT Purpose of Travel : 1. Participates/conducts OCI on landholding w/ ALI
Official Statio DARPO SANGANI PROVINCE 2. Re: Petition for re-issuance of lost title
TIME Means of Transpor- Per Total
Date Place to be visited (Destination) tation
Others
Transportation Diem Amount
Departure Arrival
3/14/2022 OS - POB. MAITUM 7:45 AM 10:50 AM VAN 300.00 1,500.00 1,800.00
POB. MAITUM - KALAONG 11:00 AM 12:10 AM MOTORHIRE 380.00 380.00
KALAONG - POB. MAITUM 2:30 PM 4:00 PM MOTORHIRE 380.00 380.00
3/15/2022 POB. MAITUM - TAKAL 8:00 AM 9:25 AM MOTORHIRE 380.00 750.00 1,130.00
TAKAL-MAGULING 12:30 PM 1:40 PM MOTORHIRE 380.00 380.00
MAGULING-POB. MAITUM 3:20 PM 4:30 PM MOTORHIRE 380.00 380.00
MAITUM-OS 4:35 PM 7:20 PM VAN 300.00 300.00
TOTAL 4,750.00
Prepared by :
I certify that : (1) I have reviewed the foregoing itinerary, (2) the PABLITO M. OMAMALIN JR
travel is necessary to the service, (3) the period covered is Signature over Printed Name
reasonable and (4) the expenses claimed are proper.
Approved by :
ATTY. KAY P. AVILES CENON S. ORIGINAL, CESO VI
ATTY. V/CHIEF LEGAL OIC-PARPO II
Signature over Printed Name
Agency Head/Authorized Representative
Republic of the Philippines
DEPARTMENT OF AGRARIAN REFORM
Tunay na Pagbabago sa Repormang Agraryo
POST-TRAVEL/ ACCOMPLISHMENT REPORT
Name: PABLITO M. OMAMALIN JR
Office: DARPO SARANGANI
Division: LEGAL DIVISION
Date of Travel Place of Travel Purpose of Travel Accomplishment
1. PARTICIPATES/CONDUCTS OCI ON PARTICIPATED/CONDUCTED OCI ON
MARCH 14, 2022
MAITUM, SARANGANI LANDHOLDING WITH ALI CASE; AND 2. RE: LANDHOLDINGS WITH ALI CASE AND WITH
PROVINCE PETITION FOR RE-ISSUANCE OF LOST PETITION FOR RE-ISSUANCE OF LOST
TITLE TITLE
1. PARTICIPATES/CONDUCTS OCI ON PARTICIPATED/CONDUCTED OCI ON
MARCH 15, 2022
MAITUM, SARANGANI LANDHOLDING WITH ALI CASE; AND 2. RE: LANDHOLDINGS WITH ALI CASE AND WITH
PROVINCE PETITION FOR RE-ISSUANCE OF LOST PETITION FOR RE-ISSUANCE OF LOST
TITLE TITLE
Prepared by: Noted by:
PABLITO M. OMAMALIN JR ATTY. KAY P. AVILES
ARPT ATTY. V/CHIEF LEGAL
QF-STO-54 Rev 00 Page 1 of 1 Eff. Date: 12/16/2020
Appendix 47
CERTIFICATE OF TRAVEL COMPLETED
Entity Name: DEPARTMENT OF AGRARIAN REFORM Fund Cluster:
________________
CENON S. ORIGINAL, CESO VI
Agency Head Station
I HEREBY CERTIFY THAT I have completed the travel as authorized in the Travel
Order/Itinerary of Travel No. ____________dated _____________under conditions indicated below:
[ X ]Strictly in accordance with the approved itinerary.
[ ] Cut short as explained below. Excess payment in the amount of P______________
was refunded under O.R No. _____________ dated _________________
[ ] Extended as explained below, Additional itinerary was submitted
[ ] Other deviation as explained below.
Explanations of justifications:
__________________________________________________________________________
Evidence of travel:
Approved travel order, Appendix "A", Certificate of Appearance
RER and Post Travel Accomplishment Report
___________________________________________________________________________
___________________________________________________________________________
Respectfully Submitted:
PABLITO M. OMAMALIN JR.
Name of Employee
On evidence and information of which I have acknowledge, the travel was actually undertaken.
Approved:
ATTY. KAY P. AVILES
ATTY. V/CHIEF LEGAL
REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF AGRARIAN REFORM
Tunay na Pagbabago sa Repormang Agraryo
CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS
Pursuant to COA Circular No. 2017-001 dated June 19, 2017
Name of Employee Pablito M. Omamalin Jr Employee No. 1204-21-0114
Office DARPO SARANGANI
Division Legal Division
Particulars Amount
Fare from DARPO Sarangani to Poblacion, Maitum on March 14, 2022 300.00
Fare from Poblacion, Maitum to DARPO Sarangani on March 15, 2022 300.00
TOTAL 600.00
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 willful falsification of statements is
punishable by law.
Certified correct: Noted by:
Signature
Print Name ATTY. NOLI L. LECHONSITO CENON S. ORIGINAL, CESO VI
Employee Immediate Supervisor
Date: Date:
