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Sample PBC

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Annex “A”

Barangay_______________________
City/Municipality of _________________
Province of ________________________

PUNONG BARANGAY’S CERTIFICATION (PBC)

PBC No. : _____________________


Date: _________________________

To: The Bank Manager


(Name of Bank)_
(Address)____

Sir/Madam:

This is to certify that the following checks were duly issued by Barangay__________,
(Ito ay pagpapatunay na ang mga cheke na nakalista sa ibaba ay na-isyu ng Barangay _____________

complete with respective Disbursement Vouchers and supporting documents.


na kompleto ng kanya-kanyang Disbursement Vouchers at kalakip na mga dokumento.)

Account No. Check No. Date Payee Amount Purpose

This Certification is issued, pursuant to COA Circular 2018-___, dated ___________,


(Itong Patunay ay ginawa alinsunod sa COA Circular 2018-____, na may petsang ________________

as a condition for the encashment of said checks.


bilang kondisyon para sa pagpapapalit ng mga nasabing cheke.)

The undersigned attests to the truthfulness of the foregoing facts, under pain of
(Pinapatototohanan ng may lagda ang mga nakasaad sa itaas, batid ang …

liability for falsification, pursuant to Article 171(4) of the Revised Penal Code.
pananagutan sa kasong “Falsification,” sang-ayon sa Article 171(4) ng Revised Penal Code.)

Very truly yours,

_________________________________
Punong Barangay

Delivered by: Received by:

Barangay Treasurer Bank Representative


Date: __________________ Date: __________________

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