Republic of the Philippines Serial No.

:
Department of Agriculture ____________________________
Philippine Center for Postharvest Development and Mechanization
Science City of Muñoz, Nueva Ecija, Philippines
www.philmech.gov.ph

X OBLIGATION REQUEST AND STATUS Date :

Fund Cluster :
BUDGET UTILIZATION REQUEST AND STATUS
01__________________________
Payee KATRINA R. SEDILLO
Office PHILMECH-SEPRD
Address Zone 2, Brgy. Sinipit Bubon, San Jose City, Nueva Ecija
Responsibility UACS Object
Particulars MFO/PAP Amount
Center Code

To obligate payment of Contracted Service for the period

SE22B
August to December 2019

(Php20,179.00 monthly with 10% premium x 5 months)

Total -
A. Certified: Charges to appropriation/alloment are B. Certified: Allotment available and obligated
necessary, lawful and under my direct supervision;and for the purpose/adjustment necessary as
supporting documents valid, proper and legal indicated above

Signature : _____________________________ Signature : ______________________________

Printed Name: RODERIC O. ______
VEREÑA Printed Name: MA. TERESA T. DIÑO
Position : Chief SRS, SEPRD Position : AOV

_____________________________
Date : ______ Date : ____________________________

C. STATUS OF OBLIGATION
Reference Amount
Balance
ORS/JEV/Check/ Obligation Payable Payment Not Yet Due and
Date Particulars
ADA/TRA No. Due Demandable

(a) (b) (c) (a-b) (b-c)

PHilMech-FD-F-006 Rev. 00 (12.05.17) *This form is generated form General Accounting Manual Vo
 Proposed
REPORT OF CHECKS ISSUED
01/28
Period Covered: ________________
2014-01-028
Agency : JDG Department Report No.: ___________
Fund : 01 1234
Bank Name/Account No. _________________ 1
Sheet No.: _______________
Check DV No. / ORS/BUR Responsibility UACS Code/
Payee MFO/PAP/KRA Amount
Date No. Payroll No. Center Code Expenditure
1/28 023 2014-02-010 010 26-036-00-00000 ABC Corporation 3 01 01 0000 50604050 03 44,000 00
123

44,000 00

CERTIFICATION
I hereby certify that this Report of Checks Issued (RCI) in _________ sheet(s) is a full,
true and correct statement of all checks issued by me in payment for obligations for the period stated and
shown in the attached disbursement vouchers.
AO 6/15/02

Juan dela Cruz 01/29/14

Disbursing Date
Officer