Disbursement Voucher 6k4215

Appendix 32 Fund Cluster : Republic of the Philippines Department of Education DIVISION OF BULACAN

City of Malolos Date : DV No. :

DISBURSEMENT VOUCHER Mode of Payment

MDS Check

Commercial Check

Payee

ADA

Others (Please specify) _________________ TIN/Employee No.: ORS/BURS No.:

Address Responsibility Center

Particulars

MFO/PAP

Amount

Amount Due A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision. ________________________________________ Printed Name, Designation and Signature

B. ing Entry: Title

UACS Code

Debit

Credit

D. Approved for Payment

C. Certified: Cash available Subject to Authority to Debit (when applicable) Sup proper Signature

Signature

Printed Name Position

Printed Name

MARIA M. SALCEDO ant III

Position

Head, ing Unit/Authorized Representative

Date

ZENIA G. MOSTOLES, Ed. D., CESO V Schools Division Superintendent Agency Head/Authorized Representative

Date

E. Receipt of Payment

JEV No.

Check/ ADA No. :

Date :

Bank Name & Number:

Signature :

Date :

Printed Name:

Official Receipt No. & Date/Other Documents Document Code: SDO-BUL-GQF-OSDS-ACC-001 Revision No.: 02 Effectivity Date: 08-18-2018 Page 1 of 1

Date