Appendix 32

Fund Cluster :

Republic of the Philippines

Department of Public Works and Highways
Camarines Sur 3rd District Engineering Office
Caraycayon, Tigaon Camarines Sur

Date :
DV No. :

DISBURSEMENT VOUCHER
Mode of
Payment

MDS Check

Commercial Check

ADA

_________________
ORS/BURS No.:

TIN/Employee No.:

JM-COFER CONSTRUCTION AND SUPPLY

Payee

Others (Please specify)

LBP-3761-0048-23

220-696-426-000

1022015-12-000150

Zone 1 No. 107 Bagumbayan Norte, Naga City

Address

Particulars

Responsibility Center

MFO/PAP

2014-4-01. Buildings and

Other Structures

268004010100201.PC

Second Partial Collection due to the above-named creditor for furnishing and delivering labor and
materials for CY-2015 BASIC EDUCATIONAL FACILITIES FUND (BEFF), SENIOR HS PROG.
CONST. OF 2 STOREY 4-CL W/ CR., BINAGASBASAN NHS, GARCHITORENA, CAM SUR as
per approved supporting papers hereto attached in the amount of.......
Contract Amount
P
6,817,556.76
38.00%
2,590,624.00
Less: Previous collection
1,744,301.54
Total value of work this billing
846,322.46
Less: 10% Retention Fee
84,632.25
Recoupment of 15% Mobilization
158,891.68
Amount this billing
602,798.53
Less: Witholding Taxes
P
G.A./1.12X5% VAT
26,910.65

G.A./1.12X2% WHT
10,764.26
37,674.91
Net Amount
P
565,123.62
15FF0049
050314S00335
Amount Due
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

Amount

565,123.62

565,123.62

LARRY D. MORENO
PROJECT ENGINEER II

B. Accounting Entry:
Account Title

UACS Code

Debit

Credit

D. Approved for Payment

C. Certified:
Cash available

Five Hundred Sixty Five Thousand One Hundred Twenty Three Pesos
62/100

Subject to Authority to Debit Account (when applicable)

Supp
proper
Signature

Signature

Printed Name
Position

Printed Name

RUEL B. BONGULTO
Chief Accountant

Position

Head, Accounting Unit/Authorized Representative

Date
E. Receipt of Payment

GEMMA B. TIMBANG
District Engineer
Agency Head/Authorized Representative

Date
JM-COFER CONST. & SUPPLY

JEV No.

Check/ ADA
No. :

Date :

Bank Name & Account Number:

Signature :

Date :

Printed Name:

Official Receipt No. & Date/Other Documents

92

Date

Appendix 32
Republic of the Philippines
Department of Public Works and Highways
Camarines Sur 3rd District Engineering Office
Caraycayon, Tigaon Camarines Sur

Fund Cluster :

Date :
DV No. :

DISBURSEMENT VOUCHER
Mode of
Payment

MDS Check

Payee

Commercial Check

ADA

Others (Please specify)

TIN/Employee No.:

Bureau of Internal Revenue

220-696-426-000

_________________
ORS/BURS No.:
1022015-12-000150

Tigaon Camarines Sur

Address

Particulars

Responsibility Center
MFO/PAP
2014-4-01. Buildings and Other Structures268004010100201.PC

To remit the 2% w/ tax and 5% VAT of JM COFER CONSTRUCTION and SUPPLY from
Second Partial Payment for CY-2015 BASIC EDUCATIONAL FACILITIES FUND (BEFF),
SENIOR HS PROG. CONST. OF 2 STOREY 4-CL W/ CR., BINAGASBASAN NHS,
GARCHITORENA, CAM SUR as per approved supporting papers hereto attached in the
amount of.......
Contract Amount
Tax Base
Less:
G.A./1.12x5% VAT
G.A./1.12x2% WHT

P
P

Amount

37,674.91

37,674.91

6,817,556.76
602,798.53

26,910.65
10,764.26
37,674.91

15FF0049
050314S00335
Amount Due
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.
LARRY D. MORENO
PROJECT ENGINEER II

B. Accounting Entry:
Account Title

UACS Code

C. Certified:
Cash available

Debit

Credit

D. Approved for Payment

Thirty Seven Thousand Six Hundred Seventy Four Pesos 91/100

Subject to Authority to Debit Account (when applicable)

Supp
proper
Signature
Printed Name
Position

Signature
Printed Name

RUEL B. BONGULTO
Chief Accountant
Head, Accounting Unit/Authorized Representative

Position

Date
E. Receipt of Payment
Check/ ADA
No. :

GEMMA B. TIMBANG
District Engineer
Agency Head/Authorized Representative

Date
JM-COFER CONST. & SUPPLY

Signature :

JEV No.

Date :

Bank Name & Account Number:

Date :

Printed Name:

Official Receipt No. & Date/Other Documents

92

Date