ANNEX B Republic of the Philippines PROVINCIAL GOVERNMENT OF KALAYAAN, LAGUNA Kalayaan, Laguna No.

100 -2006-07-

DISBURSEMENT VOUCHER
Mode of Payment Payee Address EXPLANATION
Check Cash TIN/Employee No. Other Obligation Request No.

Bureau of Treasury San Pablo City

Office/Unit/Project

Responsibility Center Code

AMOUNT

To: Payment of Fire Code Fee of this Municipality for the month of April to June 2006. As per supporting papers hereto attached in the amount of

Php

Php A. Certified:
Allotment obligated for the purpose as indicate above Supporting documents complete Signature Printed Name Position Signature

B.

Certified:
Fund Available

MERLE R. BADEL Municipal Accountant

Date:

Printed Name Position

ARSENIA R. PONCE Municipal Treasurer

Treasurer/ Authorized Representative

Head, Accounting Unit/ Authorized Representative

C.

Approved for Payment

Signature

D.

Received Payment
Bank Name:

Check No. Date: Signature

Printed Name

EMMANUEL C. MAGANA Municipal Mayor

Agency Head/ Authorized Representative

Printed Bureau Name OR/Other Documents

of Treasury
JEV No.

Position

NEX B

-2006-07-

n Request No.

AMOUNT

186.41

186.41

Date:

d Representative Date:

Date: Date:

ANNEX B Republic of the Philippines PROVINCE OF LAGUNA KALAYAAN

DISBURSEMENT VOUCHER
Mode of Payment
X
Check Cash Other

No. 100-2010-10-

ARSENIA R. PONCE Kalayaan, Laguna Address EXPLANATION

Office/Unit/Project

Obligation Request No.

100-2010-10Code

AMOUNT

To: Cas advance payment for the expenses to be incurred in LAKBAY ARAL to be held on July 27 to 29, 2012 in Ilocos Region as per suppoting papers hereto attached in the amount of . . . . . . . . . . . . . . . . . .

Php

10,400.00

Php A. Certified:
Allotment obligated for the purpose as indicate above Supporting documents complete Signature Printed Name Position Signature

10,400.00

B.

Certified:
Fund Available

MERLE R. BADEL Mun. Accountant

Date:

Printed Name Position

ARSENIA R. PONCE Municipal Treasurer

Date:

Head, Accounting Unit/ Authorized Representative

Treasurer/ Authorized Representative

C.

Approved for Payment

D.

Received Payment
Bank Name: Date:

Signature Printed Name Position Date:

Check No. Signature

LAND BANK TEODORO A. ADAO JR. Municipal Mayor

Agency Head/ Authorized Representative Printed Date: ARSENIA R. PONCE Name JEV No. Date: OR/Other Documents

JOURNAL ENTRY VOUCHER Municipality of KALAYAAN LGU

Collection Check Disbursement

ACCOUNTING ENTRIES
Account
Responsibility Center

P R Debit

AMOUNT

Accounts & Explanation

Code

Due to other NGA's Due to LGU's

416 418

186.41 336.00 17,352.25 30,040.57 26,967.02 14,763.30

Cash in bank LCCA

111

TOTAL Prepared by: ANGEL RUTH A. FERRER

89,645.55 Approved by: MERLE R. BADEL Municipal Accountant

ANNEX G-3 1000607 October 28, 2013

Cash Disbursement

AMOUNT
Credit

89,645.55

89,645.55

MERLE R. BADEL Municipal Accountant

DISBURSEMENT VOUCHER (DV)

Instructions
A. The DV shall be printed in one whole sheet of 8 1/2 x 11 size bond paper. This shall be prepared in three copies to be distributed as follows: Original - Accounting Unit Duplicate - Cash Unit Triplicate - Payee B. The Accounting Unit shall stamp the date of receipt on the face of this form. 10. Certified (Box A) - certification of the Head of Accounting Unit or his authorized representative as to obligation of allotment for the purpose as indicated and completeness of supporting documents. The certifying officer shall affix his signature, print his name, indicate his position, and the date of his signing on the spaces provided. 11. Certified (Box B) - certification by the Treasurer of his Authorized Representative on the availability of fund. 12. Approved for Payment (Boxed C) - approval by the Agency Head of his Authorized Representative on the payment covered by the DV. 13. Received Payment (Box D) - Acknowledgment by the claimant or his duly authorized representative for the receipt of the check/cash and the date of receipt. The claimant/payee shall affix his signature on the spaces provided and shall indicate the number and the date of the check, bank name and number and date of OR/ other relevant documents issued to acknowledge the receipt of payment. 14. JEV No. and Date - Number and date of the Journal Entry Voucher.

C. This form shall be accomplished in the following manner: 1. DV No. - number assigned to the DV by the Accounting Unit. It shall be nembered as follows: 0000 00 0000 Serial number (one series for each year) Month Year 2. Mode of Payment - put a check " " mark in the appropriate box opposite the mode of payment. 3. Payee - name of the payee of creditor. 4. TIN/Employee No. - Tax Identification Number (TIN) of the claimant/Identification Number assigned by the agency to the officer/employee. 5. Obligation Request No. - Number of the obligation request supporting the DV 6. Address - address of the claimant 7. Responsibility Center (Office/Unit/Project and Code) - the office/unit/project and code assigned to the cost center where the disbursement shall be charged. 8. Explanation - brief description of the disbursement. 9. Amount - amount of claim.

of the Head

of allotment

cuments.

ning on the

by the presentative

d C) - approval horized t covered

Acknowledgment

eipt. The gnature on ndicate the eck, bank name her relevant dge the receipt

d date of the