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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
Republic of the Philippines
Department of Education
Region V

SCHOOLS DIVISION OFFICE OF ALBAY

Ligon Hill, Bogtong, Legazpi City


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
Republic of the Philippines
Department of Education

Region V
SCHOOLS DIVISION
OFFICE OF ALBAY
Ligon Hill, Bogtong,
Legazpi City
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 Php485.00
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
Republic of the Philippines
Department of Education

Region V
SCHOOLS
DIVISION OFFICE OF ALBAY

Ligon Hill, Bogtong, Legazpi City


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 Php462.00
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
Republic of the Philippines
Department of
Education
Region V

SCHOOLS DIVISION OFFICE OF ALBAY

Ligon Hill, Bogtong, Legazpi City


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
EDNA R. LOPEZ
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 Php459.00
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
Republic of the Philippines
Department of Education

Region V
SCHOOLS
DIVISION OFFICE OF ALBAY

Ligon Hill, Bogtong, Legazpi City


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
MERCY R. SALVADOR
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 Php656.00
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
Republic of the Philippines
Department of Education

Region V
SCHOOLS DIVISION
OFFICE OF ALBAY
Ligon Hill,
Bogtong, Legazpi City
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
MERCY R. SALVADOR
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 Php1,871.00
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
Republic of the Philippines
Department of
Education
Region V

SCHOOLS DIVISION OFFICE OF ALBAY

Ligon Hill, Bogtong, Legazpi City


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
MERCY R. SALVADOR
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 Php1,085.00
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
Republic of the Philippines
Department of Education
Region
V
SCHOOLS DIVISION OFFICE OF
ALBAY
Ligon Hill, Bogtong, Legazpi City
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 Php650.00
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
Republic of the Philippines
Department of Education
Region V

SCHOOLS DIVISION OFFICE OF


ALBAY
Ligon Hill, Bogtong, Legazpi City
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
EDNA R. LOPEZ
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 Php468.00
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
Republic of the Philippines
Department of Education
Region V

SCHOOLS DIVISION OFFICE OF ALBAY

Ligon Hill, Bogtong, Legazpi City


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
EDNA R. LOPEZ
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 Php663.00
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
Republic of the Philippines
Department of Education
Region V

SCHOOLS DIVISION OFFICE OF ALBAY

Ligon Hill, Bogtong, Legazpi City


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
KINGSWOOD MARKETING
Address
MCKINLEY ST., LIGAO CITY
Responsibilty
Particulars MFO/PAP Amount
Center

To payment for GROCERY ITEMS AND OTHER COMMODITIES


per supporting papers hereto attached amounting to..
Amount Due Php625.00
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
Republic of the Philippines
Department of Education
Region V

SCHOOLS DIVISION OFFICE OF ALBAY

Ligon Hill, Bogtong, Legazpi City


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
JERCHEL
Address
SAN JUAN, OAS, ALBAY
Responsibilty
Particulars MFO/PAP Amount
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
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 JUANITA DELA CRUZ JUAN DELA CRUZ
Position DISBURSING OFFICER Position ESP-I
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: