ANNEX B

Republic of the Philippines

PROVINCIAL GOVERNMENT OF KALAYAAN, LAGUNA
Kalayaan, Laguna
No. 100 - -2006-07-
DISBURSEMENT VOUCHER
Mode of
Check Cash Other
Payment
TIN/Employee No. Obligation Request No.
Payee Bureau of Treasury

San Pablo City Responsibility Center

Address Office/Unit/Project Code

EXPLANATION 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: B. Certified:
Allotment obligated for the purpose as indicate above Fund Available
Supporting documents complete

Signature Signature
Printed Date: Printed
MERLE R. BADEL ARSENIA R. PONCE
Name Name
Municipal Accountant Municipal Treasurer
Position Position
Head, Accounting Unit/ Authorized Representative Treasurer/ Authorized Representative
C. Approved for Payment D. Received Payment
Check No. Bank Name:
Signature

Printed Date: Signature

EMMANUEL C. MAGANA Printed
Name Bureau of Treasury
Name
OR/Other Documents JEV No.
Municipal Mayor
Position
Agency Head/ Authorized Representative
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
No.
DISBURSEMENT VOUCHER 100-2010-10-
Mode of
X Check Cash Other
Payment
Obligation Request No.
ARSENIA R. PONCE
100-2010-10-
Kalayaan, Laguna
Address Office/Unit/Project Code

EXPLANATION AMOUNT

To: Cas advance payment for the expenses to be incurred in LAKBAY ARAL Php 10,400.00
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
A. Certified: B. Certified:
Allotment obligated for the purpose as indicate above Fund Available
Supporting documents complete

Signature Signature
Printed Date: Printed Date:
MERLE R. BADEL ARSENIA R. PONCE
Name Name
Mun. Accountant Municipal Treasurer
Position Position
Head, Accounting Unit/ Authorized Representative Treasurer/ Authorized Representative
C. Approved for Payment D. Received Payment
Check No. Bank Name: Date:
Signature
LAND BANK
Printed Date: Signature
TEODORO A. ADAO JR. Printed Date:
Name ARSENIA R. PONCE
Name
OR/Other Documents JEV No. Date:
Municipal Mayor
Position
Agency Head/ Authorized Representative
 JOURNAL ENTRY VOUCHER
Municipality of KALAYAAN
LGU

Collection Check Disbursement

ACCOUNTING ENTRIES

Account P AMOUNT
Responsibility Accounts & Explanation Code R Debit
Center

Due to other NGA's 416 186.41

Due to LGU's 418 336.00
17,352.25
30,040.57
26,967.02
14,763.30
Cash in bank LCCA 111

TOTAL 89,645.55

Prepared by: Approved by:

ANGEL RUTH A. FERRER 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.
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.
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.
 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