ABCDEFGHIJKLMNOPQRSTUVWXYZ
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(DISTRICT NAME)
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(SCHOOL NAME)
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CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS
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Pursuant to COA Circular No. 2017-001 dated June 19, 2017
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Name of EmployeeEmployee No.
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Office
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Division
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ParticularsAmount ( P )
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TOTAL0.00
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Purpose:
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I hereby certify that the above expenses are incurred as they are necessary for the aboved cited
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purpose, that above goods and services were acquired from parties not issuing receipts. And that
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I am fully aware that willful falsification of statement is punishable by law.
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Certified correct:Noted by:
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Signature
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Printed Name
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EmployeeImmediate Supervisor
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DateDate
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