Cluster :

NAPOLCOM R-IX
Date : December ,2017
DISBURSEMENT VOUCHER
DV No. : 2017-12-

Mode of
Payment MDS Check Commercial Check ADA Others (Please Specify)
TIN/Employee No.: OR/BUR No.
Payee LANDBANK OF THE PHILIPPINES 2017-12-

Address NAPOLCOM R-IX, Pagadian City

Responsibility
Particulars Center MFO/PAP Amount

To payment of CA re: 2 days Year-End and Management & Assessment Php 45,600.00
conference on Dec. 18 & 19, 2017 at Napolcom Satellite, Zam,boanga
City, as per supporting papers attached in the amount of . . . . . . . . . .

Php 45,600.00
Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.
A.
ATTY. HUSNAIRA C. ILIMIN
Acting Chief, Administrative Division
Printed Name, Designation and Signature of Supervisor
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)
ʙ Supporting documents complete and amount claimed

Signature Signature
Printed Name SHIRLEYMAR PUTAL Printed Name ATTY. PABLITO M. ABAD, JR.
Administrative Officer V Acting Regional Director
Position Head, Accounting Unit/Authorized Representative
Position
Agency Head//Authorized Representative

Date Date
Received payment JEV No.
Check/ Date Bank Name
ADA No.
Signature Date Printed Name: Date

Official Receipt/Other Documents

 OBLIGATION REQUEST AND STATUS Serial No. 2017-12-

NAPOLCOM R-IX Date: December ,2017

Agency
Fund Cluster:

Payee LANDBANK OF THE PHILIPPINES

Office NAPOLCOM R-IX, Pagadian City
Address
Responsibili UACS Code/ Amount
ty Center Particulars MFO/PAP Expenditures

To payment of CA re: 2 days Year-End and 5020502001 Php 45,600.00

Management & Assessment conference on Dec.
18 & 19, 2017 at Napolcom Satellite, Zamboanga
City, as per supporting papers attached in the
amount of . . . . . . . . . . . .

Php 45,600.00

A. Certified: Charges to appropriation/allotment are B. Certified: Allotment available and obligated for the
necessary lawful and under my direct Supervision Purpose / Adjustment necessary as indicated above.
and supporting documents valid, Proper and legal

Signature Signature
Printed Name ATTY. HUSNAIRA C. ILIMIN Printed Name SHIRLEYMAR PUTAL
Acting Chief, Administrative Division Administrative Officer V
Position Head, Requesting Office/Authorized Position Head, Requesting Office/Authorized
Representative Representative

Date Date
C. STATUS OF OBLIGATION
Reference Amount
Balance
Date Particulars ORS/JE Obligation Payable Payment Not Yet Due Due and
V/Check (a-b) Demandable
s/ADA/T (a) (b) (c) (b-c)
RA No.

Totals