Disbursement Voucher Form.xls 6q246v

ANNEX B Republic of the Philippines PROVINCIAL GOVERNMENT OF KALAYAAN, LAGUNA Kalayaan, Laguna No. 100 -

-2006-07-

DISBURSEMENT VOUCHER Mode of Payment

Check

Payee

Cash

Other

TIN/Employee No.

Bureau of Treasury

Obligation Request No.

Responsibility Center Code

San Pablo City Address

Office/Unit/Project

EXPLANATION

AMOUNT

To: Payment of Fire Code Fee of this Municipality for the month of April to June 2006. As per ing papers hereto attached in the amount of…

Php

Php A.

Certified:

B.

Certified: Fund Available

Allotment obligated for the purpose as indicate above ing documents complete Signature Printed Name Position

Signature

MERLE R. BADEL

Date:

Printed Name

Municipal ant

Position

Head, ing Unit/ Authorized Representative

C.

Approved for Payment

Name

Position

Received Payment

Check No.

Printed

Date:

EMMANUEL C. MAGANA Municipal Mayor Agency Head/ Authorized Representative

Municipal Treasurer Treasurer/ Authorized Representative

D.

Signature

ARSENIA R. PONCE

Bank Name:

Signature Printed Bureau Name OR/Other Documents

of Treasury JEV No.

NEX B

-

-2006-07-

n Request No.

AMOUNT

186.41

186.41

Date:

d Representative Date:

Date: Date:

ANNEX B Republic of the Philippines PROVINCE OF LAGUNA KALAYAAN No. 100-2010-10-

DISBURSEMENT VOUCHER Mode of Payment

X

Check

Cash

Other Obligation Request No.

ARSENIA R. PONCE

100-2010-10-

Kalayaan, Laguna Address

Office/Unit/Project

Code

EXPLANATION

AMOUNT

To: Cas advance payment for the expenses to be incurred in LAKBAY ARAL to be held on July 27 to 29, 2012 in Ilocos Region as per suppoting papers hereto attached in the amount of . . . . . . . . . . . . . . . . . .

Php

10,400.00

Php A.

Certified:

B.

10,400.00

Certified: Fund Available

Allotment obligated for the purpose as indicate above ing documents complete Signature Printed Name Position

Signature

MERLE R. BADEL

Date:

Printed Name

Mun. ant

Position

Head, ing Unit/ Authorized Representative

C.

Approved for Payment

Position

Municipal Treasurer

Received Payment

Check No.

Bank Name:

Date:

LAND BANK

Printed Name

Date:

Treasurer/ Authorized Representative

D.

Signature

ARSENIA R. PONCE

Date:

TEODORO A. ADAO JR. Municipal Mayor Agency Head/ Authorized Representative

Signature Printed Date: ARSENIA R. PONCE Name JEV No. Date: OR/Other Documents

JOURNAL ENTRY VOUCHER Municipality of KALAYAAN LGU Collection

Check Disbursement

ING ENTRIES

s & Explanation

Responsibility



P

Code

R

AMOUNT Debit

Center

Due to other NGA's Due to LGU's

Cash in bank LCCA

416 418

111

TOTAL Prepared by: ANGEL RUTH A. FERRER

186.41 336.00 17,352.25 30,040.57 26,967.02 14,763.30

89,645.55 Approved by: MERLE R. BADEL Municipal ant

ANNEX G-3 1000607 October 28, 2013

Cash Disbursement

AMOUNT

MERLE R. BADEL Municipal ant

Credit

89,645.55

89,645.55

DISBURSEMENT VOUCHER (DV) Instructions A. The DV shall be printed in one whole sheet of 8 1/2 x 11 size bond paper. This shall be prepared in three copies to be distributed as follows: Original - ing Unit Duplicate - Cash Unit Triplicate - Payee B.

The ing Unit shall stamp the date of receipt on the face of this form.

C. This form shall be accomplished in the following manner: 1. DV No. - number assigned to the DV by the ing Unit. It shall be nembered as follows: 0000 00 0000 Serial number (one series for each year) Month Year 2. Mode of Payment - put a check " " mark in the appropriate box opposite the mode of payment. 3. Payee - name of the payee of creditor. 4. TIN/Employee No. - Tax Identification Number (TIN) of the claimant/Identification Number assigned by the agency to the officer/employee. 5. Obligation Request No. - Number of the obligation request ing the DV 6. Address - address of the claimant 7. Responsibility Center (Office/Unit/Project and Code) - the office/unit/project and code assigned to the cost center where the disbursement shall be charged. 8. Explanation - brief description of the disbursement. 9. Amount - amount of claim.

10. Certified (Box A) - certification of the Head of ing Unit or his authorized representative as to obligation of allotment for the purpose as indicated and completeness of ing documents. The certifying officer shall affix his signature, print his name, indicate his position, and the date of his g on the spaces provided. 11. Certified (Box B) - certification by the Treasurer of his Authorized Representative on the availability of fund. 12. Approved for Payment (Boxed C) - approval by the Agency Head of his Authorized Representative on the payment covered by the DV. 13. Received Payment (Box D) - Acknowledgment by the claimant or his duly authorized representative for the receipt of the check/cash and the date of receipt. The claimant/payee shall affix his signature on the spaces provided and shall indicate the number and the date of the check, bank name and number and date of OR/ other relevant documents issued to acknowledge the receipt of payment. 14. JEV No. and Date - Number and date of the Journal Entry Voucher.

of the Head

of allotment

cuments.

ning on the

by the presentative

d C) - approval horized t covered

Acknowledgment

eipt. The gnature on ndicate the eck, bank name her relevant dge the receipt

d date of the