ANNEX A

Department of Education
DIVISION OF SURIGAO DEL NORTE
Rizal St. , Surigao City

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS

Pursuan to COA Circular No. 2017-001 dated June 19, 2017

Employee
Name of Employee ROLITO WINES
No.
Office DEPED, DIVISION OF SURIGAO DEL NORTE
Division SURIGAO DEL NORTE
Particulars Amount

Tricycle (Office to Terminal) 9.00

Multicab (Sison-Surigao Terminal) 20.00
Multicab (Terminal-Div. Office) 9.00

TOTAL 38.00
Purpose
Submit Appointment to CSC at Sison SDN

I hereby certify that the above expenses are incuured 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 by law.

Certified correct Noted by:

Signature
Printed Name ROLITO WINES MARY JANE M. ROSALES
Date: 9/25/2018 Date :