SALVACION HIGH SCHOOL Fund Cluster :

Entity Name
Date :
DISBURSEMENT VOUCHER DV No. :
(Yr/Month/Serial No)
Mode of
Payment MDS Check Commercial Check ADA Others (Please specify)
TIN No.: _________________
ORS/BURS No.:
Payee NILDA B. BORJAL
Address SALVACION, SIPOCOT, CAMARINES SUR
Responsibility
Particulars MFO/PAP Amount
Center

PAYMENT FOR UTILITY LABOR FROM AUGUST 22 &23 TO

OCTOBER 31, 2019 WITH ATTACHED SUPPORTING
DOCUMENTS WITH THE AMOUNT OF…

August 22 &23, 2019 542.80

September 1-30, 2019 4,885.20

October 1-31, 2019 4,885.20

Amount Due P 10, 313.20

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

CLODUALDO C. LOPEZ JR.

Head Teacher I
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)
Support
proper
Signature Signature
Printed Name JEMAR V. RECACHO Printed Name CLODUALDO C. LOPEZ JR.
SENIOR BOOKKEEPER HEAD TEACHER I
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
92
 Date : Bank Name & Account Number:
Check/ADA No.:
LBP- Sipocot / 2092-1068-99
Date : Printed Name: Date
Signature :
NILDA B. BORJAL
Official Receipt No. & Date/Other Documents

92
 SALVACION HIGH SCHOOL Fund Cluster :
Entity Name
Date :
DISBURSEMENT VOUCHER DV No. :
(Yr/Month/Serial No)
Mode of
Payment MDS Check Commercial Check ADA Others (Please specify)
TIN No.: _________________
ORS/BURS No.:
Payee CLODUALDO C. LOPEZ JR.
5007170
Address SALVACION HIGH SCHOOL
Responsibility
Particulars MFO/PAP Amount
Center

Amount Due
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

CLODUALDO C. LOPEZ JR.

Head Teacher I
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)
Support
proper
Signature Signature
Printed Name JEMAR V. RECACHO Printed Name CLODUALDO C. LOPEZ JR.
SENIOR BOOKKEEPER HEAD TEACHER I
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
92
 Date : Bank Name & Account Number:
Check/ADA No.:
LBP- Sipocot / 2092-1068-99
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents

92
 SALVACION HIGH SCHOOL Fund Cluster :
Entity Name
Date :
DISBURSEMENT VOUCHER DV No. :
(Yr/Month/Serial No)
Mode of
Payment MDS Check Commercial Check ADA Others (Please specify)
TIN No.: _________________
ORS/BURS No.:
Payee LORENZO B. HERNANDO
Address CALAGBANGAN, SIPOCOT, CAMARINES SUR
Responsibility
Particulars MFO/PAP Amount
Center

PAYMENT FOR TLS LABOR FROM TEMPORARY

LEARNING SPACE FUND 2019 WITH ATTACHED SUPPORTING
DOCUMENTS WITH THE AMOUNT OF…

Amount Due
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

CLODUALDO C. LOPEZ JR.

Head Teacher I
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)
Support
proper
Signature Signature
Printed Name HANZEL DESUYO-PEL Printed Name CLODUALDO C. LOPEZ JR.
TEACHER 1/DISBURSING OFFICER HEAD TEACHER I
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
92
 Date : Bank Name & Account Number:
Check/ADA No.:
LBP- Sipocot / 2092-1068-99
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents

92
 SALVACION HIGH SCHOOL Fund Cluster :
Entity Name
Date :
DISBURSEMENT VOUCHER DV No. :
(Yr/Month/Serial No)
Mode of
Payment MDS Check Commercial Check ADA Others (Please specify)
TIN No.: _________________
ORS/BURS No.:
Payee ANGELINE LIPIAO ESPIRITU
923-819-678-000
Address SIPOCOT, CAMARINES SUR
Responsibility
Particulars MFO/PAP Amount
Center

PAYMENT FOR THE CONSTRUCTION MATERIALS OF

ONE TLS WITH ATTACHED SUPPORTING DOCUMENTS
AND OFFICIAL RECEIPT WITH THE AMOUNT OF -------

Amount Due P 60,700.36

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

CLODUALDO C. LOPEZ JR.

Head Teacher I
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)
Support
proper
Signature Signature
Printed Name JEMAR V. RECACHO Printed Name CLODUALDO C. LOPEZ JR.
SENIOR BOOKKEEPER HEAD TEACHER I
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
92
 Date : Bank Name & Account Number:
Check/ADA No.:
LBP- Sipocot / 2092-1068-99
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents

92
 SALVACION HIGH SCHOOL Fund Cluster :
Entity Name
Date :
DISBURSEMENT VOUCHER DV No. :
(Yr/Month/Serial No)
Mode of
Payment MDS Check Commercial Check ADA Others (Please specify)
TIN No.: _________________
ORS/BURS No.:
Payee HANZEL DESUYO-PEL
5811090
Address SALVACION HIGH SCHOOL
Responsibility
Particulars MFO/PAP Amount
Center

REIMBURSEMENT FOR THE SPORTS EQUIPMENT

WITH ATTACHED PERTINENT DOCUMENTS AND OFFICIAL
RECEIPT IN THE AMOUNT OF ……

Amount Due P 4,646.73

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

CLODUALDO C. LOPEZ JR.

Head Teacher I
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)
Support
proper

Signature Signature

Printed Name HANZEL DESUYO-PEL Printed Name CLODUALDO C. LOPEZ JR.

TEACHER 1/DISBURSING OFFICER HEAD TEACHER I
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date of Payment
E. Receipt Date JEV No.
Date : Bank Name & Account Number:
Check/ADA No.:
LBP- Sipocot / 2092-1068-99

92
 Date : Bank Name & Account Number:
Check/ADA No.:
LBP- Sipocot / 2092-1068-99
Signature : Date : Printed Name: Date
Official Receipt No. & Date/Other Documents HANZEL DESUYO-PEL

92
 SALVACION HIGH SCHOOL Fund Cluster :
Entity Name
Date :
DISBURSEMENT VOUCHER DV No. :
(Yr/Month/Serial No)
Mode of
Payment MDS Check Commercial Check ADA Others (Please specify)
Employee No..: _________________
ORS/BURS No.:
Payee HANZEL DESUYO-PEL
5811090
Address CALAGBANGAN, SIPOCOT, CAMARINES SUR
Responsibility
Particulars MFO/PAP Amount
Center

REIMBURSEMENT FOR 50 STUDENTS INSURANCE

AS PER OFFICIAL RECEIPT AND DOCUMENTS
ATTACHED HEREWITH IN THE AMOUNT OF…..

Amount Due p 1,500.00

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

CLODUALDO C. LOPEZ JR.

Head Teacher I
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)
Support
proper
Signature Signature
Printed Name HANZEL DESUYO-PEL Printed Name CLODUALDO C. LOPEZ JR.
TEACHER 1/DISBURSING OFFICER HEAD TEACHER I
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Date : Bank Name & Account Number:
Check/ADA No.:
LBP- Sipocot / 2092-1068-99
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents

92
 SALVACION HIGH SCHOOL Fund Cluster :
Entity Name
Date :
DISBURSEMENT VOUCHER DV No. :
(Yr/Month/Serial No)
Mode of
Payment MDS Check Commercial Check ADA Others (Please specify)
Employee No.: _________________
ORS/BURS No.:
Payee HANZEL DESUYO-PEL
5811090
Address CALAGBANGAN, SIPOCOT, CAMARINES SUR
Responsibility
Particulars MFO/PAP Amount
Center

REIMBURSEMENT FOR LIGHTING POST SUPPLIES

AS PER OFFICIAL RECEIPT AND DOCUMENTS
ATTACHED HEREWITH IN THE AMOUNT OF…..

Amount Due
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

CLODUALDO C. LOPEZ JR.

Head Teacher I
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)
Support
proper
Signature Signature
Printed Name HANZEL DESUYO-PEL Printed Name CLODUALDO C. LOPEZ JR.
TEACHER 1/DISBURSING OFFICER HEAD TEACHER I
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative

92
 Date Date
E. Receipt of Payment JEV No.
Date : Bank Name & Account Number:
Check/ADA No.:
LBP- Sipocot / 2092-1068-99
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents

92
 SALVACION HIGH SCHOOL Fund Cluster :
Entity Name
Date :
DISBURSEMENT VOUCHER DV No. :
(Yr/Month/Serial No)
Mode of
Payment MDS Check Commercial Check ADA Others (Please specify)
TIN No.: _________________
ORS/BURS No.:
Payee DANIEL C. SOZALO 923-448-930-000
Address 68 RIZAL ST. STA CATALINA, PAGBILAO, QUEZON
Responsibility
Particulars MFO/PAP Amount
Center

PAYMENT FOR THE PRODUCTION OF STUDENT ID

FROM GRADE 7,8,9,10 S/Y 2019-2020 FOR THE MONTH OF
AUGUST 2019 AS PER SUPPORTING DOCUMENTS, AND
OFFICIAL RECEIPT IN THE AMOUNT OF………..

Amount Due P 7,880.00

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

CLODUALDO C. LOPEZ JR.

Head Teacher I
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)
Support
proper
Signature Signature
Printed Name HANZEL DESUYO-PEL Printed Name CLODUALDO C. LOPEZ JR.
TEACHER 1/DISBURSING OFFICER HEAD TEACHER I
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Date : Bank Name & Account Number:
Check/ADA No.:
LBP- Sipocot / 2092-1068-99
Date : Printed Name: Date
Signature :
DANIEL C. SOZALO
Official Receipt No. & Date/Other Documents

92
 SALVACION HIGH SCHOOL Fund Cluster :
Entity Name
Date :
DISBURSEMENT VOUCHER DV No. :
(Yr/Month/Serial No)
Mode of
Payment MDS Check Commercial Check ADA Others (Please specify)
Employee No.: _________________
ORS/BURS No.:
Payee HANZEL DESUYO-PEL
5811090
Address CALAGBANGAN, SIPOCOT, CAMARINES SUR
Responsibility
Particulars MFO/PAP Amount
Center

REIMBURSEMENT FOR ELECTRIC BILL FOR THE MONTH OF

FEBRUARY - APRIL 2019 AS PER SUPPORTING STATEMENT OF
ACCOUNT AND OFFICIAL RECIEPT ATTACHED HEREWITH
IN THE AMOUNT OF …….

Amount Due P 2,870.74

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

CLODUALDO C. LOPEZ JR.

Head Teacher I
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)
Support
proper
Signature Signature
Printed Name HANZEL DESUYO-PEL Printed Name CLODUALDO C. LOPEZ JR.
TEACHER 1/DISBURSING OFFICER HEAD TEACHER I
Position Position

92
 Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Date : Bank Name & Account Number:
Check/ADA No.:
LBP- Sipocot / 2092-1068-99
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents

92
 SALVACION HIGH SCHOOL Fund Cluster :
Entity Name
Date :
DISBURSEMENT VOUCHER DV No. :
(Yr/Month/Serial No)
Mode of
Payment MDS Check Commercial Check ADA Others (Please specify)
TIN No.: _________________
ORS/BURS No.:
Payee CAMARINES SUR I ELECTRIC COOPERATIVE, INC.
000-620-935-002
Address SAN JUAN AVE., SOUTH CENTRO, SIPOCOT, CAMARINES SUR
Responsibility
Particulars MFO/PAP Amount
Center

PAYMENT FOR ELECTRIC BILL FOR THE MONTH OF

_____________________________ AS PER SUPPORTING STATEMENT OF
ACCOUNT AND OFFICIAL RECIEPT ATTACHED HEREWITH
IN THE AMOUNT OF………

Amount Due
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

CLODUALDO C. LOPEZ JR.

Head Teacher I
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)
Support
proper
Signature Signature
Printed Name JEMAR V. RECACHO Printed Name CLODUALDO C. LOPEZ JR.
SENIOR BOOKKEEPER HEAD TEACHER I
Position Position

92
 Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Date : Bank Name & Account Number:
Check/ADA No.:
LBP- Sipocot / 2092-1068-99
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents

92
 SALVACION HIGH SCHOOL Fund Cluster :
Entity Name
Date :
DISBURSEMENT VOUCHER DV No. :
(Yr/Month/Serial No)
Mode of
Payment MDS Check Commercial Check ADA Others (Please specify)
TIN/Employee No.: _________________
ORS/BURS No.:
Payee HANZEL DESUYO-PEL
5811090
Address CALAGBANGAN, SIPOCOT, CAMARINES SUR
Responsibility
Particulars MFO/PAP Amount
Center

TO REIMBURSE THE TRAVEL EXPENSES,

REGISTRATION FEE AND PER DIEM DURING SEMINAR,
CONFERENCES AND OTHER OFFICIAL BUSINESS ATTENDED
ON OCTOBER 3, 11, 22, NOVEMBER 5 & 13, 2019 AS PER
SUPPORTING OFFICIAL RECEIPT, DOCUMENTS AND
CERTIFICATION ATTACHED HEREWITH IN THE
AMOUNT OF….

Amount Due P 1,658.00

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

CLODUALDO C. LOPEZ JR.

Head Teacher I
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)
Support
proper
Signature Signature
Printed Name JEMAR V. RECACHO Printed Name CLODUALDO C. LOPEZ JR.
SENIOR BOOKKEEPER HEAD TEACHER I
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.

92
 Date : Bank Name & Account Number:
Check/ADA No.:
LBP- Sipocot / 2092-1068-99
Date : Printed Name: Date
Signature :
HANZEL DESUYO-PEL
Official Receipt No. & Date/Other Documents

92
 SALVACION HIGH SCHOOL Fund Cluster :
Entity Name
Date :
DISBURSEMENT VOUCHER DV No. :
(Yr/Month/Serial No)
Mode of
Payment MDS Check Commercial Check ADA Others (Please specify)
TIN.: _________________
ORS/BURS No.:
Payee FRYDT PHARMACY
Address
Responsibility
Particulars MFO/PAP Amount
Center

PAYMENT FOR MEDICAL SUPPLIES

AS PER OFFICIAL RECEIPT AND DOCUMENTS
ATTACHED HEREWITH IN THE AMOUNT OF…..

Amount Due P 999.00

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

CLODUALDO C. LOPEZ JR.

Head Teacher I
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)
Support
proper
Signature Signature
Printed Name HANZEL DESUYO-PEL Printed Name CLODUALDO C. LOPEZ JR.
TEACHER 1/DISBURSING OFFICER HEAD TEACHER I
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Date : Bank Name & Account Number:
Check/ADA No.:
LBP- Sipocot / 2092-1068-99
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents

92
 SALVACION HIGH SCHOOL Fund Cluster :
Entity Name
Date :
DISBURSEMENT VOUCHER DV No. :
(Yr/Month/Serial No)
Mode of
Payment MDS Check Commercial Check ADA Others (Please specify)
TIN No.: _________________
ORS/BURS No.:
Payee EVANGELINE LIPIAO ESPIRITU

Address SIPOCOT, CAMARINES SUR

Responsibility
Particulars MFO/PAP Amount
Center

PAYMENT OF CONSTRUCTION MATERIALS FOR TLS FOR

THE MONTH OF AUGUST AS PER SUPPORTING DOCUMENTS
SALES INVOICE RECEIPT IN THE AMOUNT OF ……

Amount Due P 60,700.36

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

CLODUALDO C. LOPEZ JR.

Head Teacher I
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)
Support
proper
Signature Signature
Printed Name HANZEL DESUYO-PEL Printed Name CLODUALDO C. LOPEZ JR.
TEACHER 1/DISBURSING OFFICER HEAD TEACHER I
Position Position

92
 Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Date : Bank Name & Account Number:
Check/ADA No.:
LBP- Sipocot / 2092-1068-99
Date : Date
Signature :

Official Receipt No. & Date/Other Documents

92
 SALVACION HIGH SCHOOL Fund Cluster :
Entity Name
Date :
DISBURSEMENT VOUCHER DV No. :
(Yr/Month/Serial No)
Mode of
Payment MDS Check Commercial Check ADA Others (Please specify)
TIN/Employee No.: _________________
ORS/BURS No.:
Payee CLODUALDO C. LOPEZ JR.
5007170
Address ANIB, SIPOCOT, CAMARINES SUR
Responsibility
Particulars MFO/PAP Amount
Center

REIMBURSEMENT FOR THE COMMUNICATION EXPENSES-

TEL. EXPENSES-MOBILE FOR THE MONTH OF JULY 2019
AS PER SUPPORTING PREPAID CARD AND OFFICIAL
RECEIPT ATTACHED HEREWITH IN THE AMOUNT OF …….

Amount Due P 600.00

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

CLODUALDO C. LOPEZ JR.

Head Teacher I
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)
Support
proper
Signature Signature
Printed Name JEMAR V. RECACHO Printed Name CLODUALDO C. LOPEZ JR.
SENIOR BOOKKEEPER HEAD TEACHER I
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative

92
 Date Date
E. Receipt of Payment JEV No.
Date : Bank Name & Account Number:
Check/ADA No.:
LBP- Sipocot / 2092-1068-99
Date : Printed Name: Date
Signature :
CLODUALDO C. LOPEZ JR.
Official Receipt No. & Date/Other Documents

92
 SALVACION HIGH SCHOOL Fund Cluster :
Entity Name
Date :
DISBURSEMENT VOUCHER DV No. :
(Yr/Month/Serial No)
Mode of
Payment MDS Check Commercial Check ADA Others (Please specify)
TIN/Employee No.: _________________
ORS/BURS No.:
Payee CLODUALDO C. LOPEZ JR.
5007170
Address ANIB, SIPOCOT, CAMARINES SUR
Responsibility
Particulars MFO/PAP Amount
Center

REIMBURSEMENT OF FIDELITY BOND FROM APRIL 25, 2019

TO APRIL 24, 2020 AS PER SUPPORTING DOCUMENTS
CONFIRMATION LETTER, AUTHORITY TO ACCEPT PAYMENT
AND VALIDATED BANK DEPOSIT ATTACHED HEREWITH IN THE
AMOUNT OF ….

Amount Due P 3,375.00

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

CLODUALDO C. LOPEZ JR.

Head Teacher I
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)
Support
proper
Signature Signature
Printed Name HANZEL DESUYO-PEL Printed Name CLODUALDO C. LOPEZ JR.
TEACHER 1/DISBURSING OFFICER HEAD TEACHER I
Position Position

92
 Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Date : Bank Name & Account Number:
Check/ADA No.:
LBP- Sipocot / 2092-1068-99
Date : Printed Name: Date
Signature :
CLODUALDO C. LOPEZ JR.
Official Receipt No. & Date/Other Documents

92
 SALVACION HIGH SCHOOL Fund Cluster :
Entity Name
Date :
DISBURSEMENT VOUCHER DV No. :
(Yr/Month/Serial No)
Mode of
Payment MDS Check Commercial Check ADA Others (Please specify)
TIN/Employee No.: _________________
ORS/BURS No.:
Payee HANZEL DESUYO-PEL
5811090
Address CALAGBANGAN, SIPOCOT, CAMARINES SUR
Responsibility
Particulars MFO/PAP Amount
Center

REIMBURSEMENT OF FIDELITY BOND FROM FEB. 14, 2019

TO FEB. 13, 2020 AS PER SUPPORTING DOCUMENTS
CONFIRMATION LETTER, AUTHORITY TO ACCEPT PAYMENT
AND VALIDATED BANK DEPOSIT ATTACHED HEREWITH IN THE
AMOUNT OF ….

Amount Due P 3,375.00

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

CLODUALDO C. LOPEZ JR.

Head Teacher I
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)
Support
proper
Signature Signature
Printed Name HANZEL DESUYO-PEL Printed Name CLODUALDO C. LOPEZ JR.
TEACHER 1/DISBURSING OFFICER HEAD TEACHER I
Position Position

92
 Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Date : Bank Name & Account Number:
Check/ADA No.:
LBP- Sipocot / 2092-1068-99
Date : Printed Name: Date
Signature :
HANZEL DESUYO-PEL
Official Receipt No. & Date/Other Documents

92