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Appendix 44
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LIQUIDATION REPORTSerial No.: _________________
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Period Covered ________________Date: _____________________
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Entity Name : _____________________________________________Responsibility Center Code:
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Fund Cluster : _______________________________________________________________________
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PARTICULARSAMOUNT
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TOTAL AMOUNT SPENT
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AMOUNT OF CASH ADVANCE PER DV NO.______DTD. ______
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AMOUNT REFUNDED PER OR NO. ________DTD. ___________
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AMOUNT TO BE REIMBURSED
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 A Certified: Correctness of the Certified: Purpose of travel / Certified: Supporting documents complete and proper
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 above data
cash advance duly accomplished
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________________________________________________________________________
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 Signature over Printed NameSignature over Printed NameSignature over Printed Name
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ClaimantImmediate SupervisorHead, Accounting Division Unit
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JEV No.: ___________________
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Date: ______________________Date: _____________________Date: _____________________
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