DISBURSEMENT Voucher Sample

Republic of the Philippines
Department of Education
Region V
DIVISION OF ALBAY
Ligon Hill, Bogtong, Legazpi City
DISBURSEMENT VOUCHER
Mode of Payment
MDS Check Commercial Check ADA
TIN/Employee
Payee:
Responsibilit
Address: Funding Source:
Organization Code
Location Code:
EXPLANATION
MFO/FAP Object Code
A. Certified: B. Approved for Payment

B. Approved for Payment
Cash Available
Subject to ADA [when applicable]
Supporting documents complete
Signature Signature
Printed Name RAFAEL B. TRAJANO Printed Name BEBI
Position Division Accountant Position Schools
Date Date
C. Received Payment:
Bank Name Date
Check/ADA No.:
Printed Name Date
Signature:
OR No. / Other relevant document

e Philippines
f Education
nV
OF ALBAY
ng, Legazpi City
Number
ADA Others
TIN/Employee ObR No.
Responsibility Center
Organization Code: 07001085001
Location Code: 050506046
AMOUNT
Php
Php -
pproved for Payment
pproved for Payment
BEBIANO I. SENTILLAS
Schools Division Superintendent
JEV Number
Date
Date
Date
Region V
SCHOOLS DIVISION OFFICE OF ALBAY

Telefax : (052) 481-5939. Website: www.depedalbay.com.ph
Fund Cluster :
101101
101407
DISBURSEMENT VOUCHER 104102

Others: _________
Date :
DV No. :
Mode of Others (Please specify)

Payment MDS Check Commercial Check ADA
TIN/Employee No. : ORS/BURS No.:

Payee
JOSE R. REGLOS
Address
CENTRO, OAS, ALBAY
Responsibilty
Particulars MFO/PAP Amount
Center
To payment for GROCERY ITEMS AND OTHER COMMODITIES

per supporting papers hereto attached amounting to..
Amount Due Php2,576.00
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.
_______________________________________________________________
B. Accounting Entry:
Account Title UACS Code Debit Credit
C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Supporting document complete and amount claimed proper
Signature Signature
Printed
Printed Name
Name TRINIDAD R. OSCURO MARCEL B. RENOLAYAN
Position DISBURSING OFFICER Position ESP-I
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date: Bank Name & Account Number:
No.:
Signature: Date: Printed Name: Date:
Official Receipt No. & Date/Other Documents
Region V
SCHOOLS DIVISION
OFFICE OF ALBAY
Ligon Hill, Bogtong,
Legazpi City
Fund Cluster :
101101
101407

Others: _________
Date :
DV No. :


Payee
JOSE R. REGLOS
Address
CENTRO, OAS, ALBAY
Responsibilty
Center

Amount Due Php485.00
_______________________________________________________________

Cash available
Signature Signature
Printed
Printed Name
Date Date
No.:
Region V
SCHOOLS
DIVISION OFFICE OF ALBAY

Fund Cluster :
101101
101407

Others: _________
Date :
DV No. :


Payee
JOSE R. REGLOS
Address
CENTRO, OAS, ALBAY
Responsibilty
Center

_______________________________________________________________

Cash available
Signature Signature
Printed
Printed Name
Date Date
No.:
Department of
Education
Region V

Fund Cluster :
101101
101407

Others: _________
Date :
DV No. :


Payee
EDNA R. LOPEZ
Address
CENTRO, OAS, ALBAY
Responsibilty
Center

_______________________________________________________________

Cash available
Signature Signature
Printed
Printed Name
Date Date
No.:
Region V
SCHOOLS
DIVISION OFFICE OF ALBAY

Fund Cluster :
101101
101407

Others: _________
Date :
DV No. :


Payee
MERCY R. SALVADOR
Address
CENTRO, OAS, ALBAY
Responsibilty
Center

_______________________________________________________________

Cash available
Signature Signature
Printed
Printed Name
Date Date
No.:
Region V
SCHOOLS DIVISION
OFFICE OF ALBAY
Ligon Hill,
Bogtong, Legazpi City
Fund Cluster :
101101
101407

Others: _________
Date :
DV No. :


Payee
MERCY R. SALVADOR
Address
CENTRO, OAS, ALBAY
Responsibilty
Center

_______________________________________________________________

Cash available
Signature Signature
Printed
Printed Name
Date Date
No.:
Department of
Education
Region V

Fund Cluster :
101101
101407

Others: _________
Date :
DV No. :


Payee
MERCY R. SALVADOR
Address
CENTRO, OAS, ALBAY
Responsibilty
Center

_______________________________________________________________

Cash available
Signature Signature
Printed
Printed Name
Date Date
No.:
Region
V
SCHOOLS DIVISION OFFICE OF
ALBAY
Fund Cluster :
101101
101407

Others: _________
Date :
DV No. :


Payee
JOSE R. REGLOS
Address
CENTRO, OAS, ALBAY
Responsibilty
Center

_______________________________________________________________

Cash available
Signature Signature
Printed
Printed Name
Date Date
No.:
Region V
SCHOOLS DIVISION OFFICE OF

ALBAY
Fund Cluster :
101101
101407

Others: _________
Date :
DV No. :


Payee
EDNA R. LOPEZ
Address
CENTRO, OAS, ALBAY
Responsibilty
Center

_______________________________________________________________

Cash available
Signature Signature
Printed
Printed Name
Date Date
No.:
Region V

Fund Cluster :
101101
101407

Others: _________
Date :
DV No. :


Payee
EDNA R. LOPEZ
Address
CENTRO, OAS, ALBAY
Responsibilty
Center

_______________________________________________________________

Cash available
Signature Signature
Printed
Printed Name
Date Date
No.:
Region V

Fund Cluster :
101101
101407

Others: _________
Date :
DV No. :


Payee
KINGSWOOD MARKETING
Address
MCKINLEY ST., LIGAO CITY
Responsibilty
Center

_______________________________________________________________

Cash available
Signature Signature
Printed
Printed Name
Date Date
No.:
Region V

Fund Cluster :
101101
101407

Others: _________
Date :
DV No. :


Payee
JERCHEL
Address
SAN JUAN, OAS, ALBAY
Responsibilty
Center
P 1,275.00
To payment for 17 BUNDLES of FIREWOOD @ 75php each and other per

supporting papers here to attached amounting to:
Amount Due:
Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision. P 1,275.00
_______________________________________________________________
JUAN DELA CRUZ
B. Accountin ESP-1
Account Title UACS Code Debit
Credit
Cash available
Signature Signature
Printed
Printed Name
Name JUANITA DELA CRUZ JUAN DELA CRUZ
Date Date
E. Receipt of Payment
Check/ ADA Date: Bank Name & Account Number: JEV No.
No.:
Signature: Date: Printed Name:
Official Receipt No. & Date/Other Documents Date:

DISBURSEMENT Voucher Sample

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Republic of the Philippines

MFO/FAP Object Code

A. Certified: B. Approved for Payment

OR No. / Other relevant document

Location Code: 050506046

SCHOOLS DIVISION OFFICE OF ALBAY

Ligon Hill, Bogtong, Legazpi City

DISBURSEMENT VOUCHER 104102

Mode of Others (Please specify)

TIN/Employee No. : ORS/BURS No.:

To payment for GROCERY ITEMS AND OTHER COMMODITIES

C. Certified: D. Approved for Payment

DISBURSEMENT VOUCHER 104102

Mode of Others (Please specify)

TIN/Employee No. : ORS/BURS No.:

To payment for GROCERY ITEMS AND OTHER COMMODITIES

C. Certified: D. Approved for Payment

Ligon Hill, Bogtong, Legazpi City

DISBURSEMENT VOUCHER 104102

Mode of Others (Please specify)

TIN/Employee No. : ORS/BURS No.:

To payment for GROCERY ITEMS AND OTHER COMMODITIES

C. Certified: D. Approved for Payment

SCHOOLS DIVISION OFFICE OF ALBAY

Ligon Hill, Bogtong, Legazpi City

DISBURSEMENT VOUCHER 104102

Mode of Others (Please specify)

TIN/Employee No. : ORS/BURS No.:

To payment for GROCERY ITEMS AND OTHER COMMODITIES

C. Certified: D. Approved for Payment

Ligon Hill, Bogtong, Legazpi City

DISBURSEMENT VOUCHER 104102

Mode of Others (Please specify)

TIN/Employee No. : ORS/BURS No.:

To payment for GROCERY ITEMS AND OTHER COMMODITIES

C. Certified: D. Approved for Payment

DISBURSEMENT VOUCHER 104102

Mode of Others (Please specify)

TIN/Employee No. : ORS/BURS No.:

To payment for GROCERY ITEMS AND OTHER COMMODITIES

C. Certified: D. Approved for Payment

SCHOOLS DIVISION OFFICE OF ALBAY

Ligon Hill, Bogtong, Legazpi City

DISBURSEMENT VOUCHER 104102

Mode of Others (Please specify)

TIN/Employee No. : ORS/BURS No.:

To payment for GROCERY ITEMS AND OTHER COMMODITIES

C. Certified: D. Approved for Payment

DISBURSEMENT VOUCHER 104102

Mode of Others (Please specify)

TIN/Employee No. : ORS/BURS No.:

To payment for GROCERY ITEMS AND OTHER COMMODITIES

C. Certified: D. Approved for Payment

SCHOOLS DIVISION OFFICE OF

DISBURSEMENT VOUCHER 104102

Mode of Others (Please specify)

TIN/Employee No. : ORS/BURS No.:

To payment for GROCERY ITEMS AND OTHER COMMODITIES

C. Certified: D. Approved for Payment