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Republic of the Philippines

PROVINCIAL GOVERNMENT OF CAPIZ


Capitol Building, Roxas City
No.

DISBURSEMENT VOUCHER
Mode of
Payment

Check

Cash

Others

WWIL

Payee

TIN/Employee No.

Obligation Request No.

Hon. Blesilda P. Almalbis


S.P

ADDDRESS

Pob. Pilar, Capiz

Office/Unit Project

EXPLANATION

Responsibility Center
Code

AMOUNT

To Reimbursement, My traveling expenses (Perdiem) while on monitoring of various


projects in the different areas of my responsibility for the month of July, 2010. Chargeable
to my travel Expenses Fund. As per supporting papers hereto attached with the total
amount of..
Recommending for Approval:
Hon. Blesilda P. Almalbis
Board Member
Province of Capiz
Amount Due:
A

Certified

Certified

Allotment obligated for the purpose as


indicated above
Supporting documents complete

Signature
Printed
Name
Position
C.

Signature
ERNIE B. ARCENAS

Date

Provincial Accountant
Head, Requesting Office/Authorized Representative

Approved for Payment

Date

Provincial Treasurer

Position

Head, Budget Unit / Authorized Representative

Date

Date
Hon. Esteban Evan B. Contreras

Vice Governor

Position

WENDIZIMA SUSTENTO

D. Received Payment
Check No.
Bank Name

Signature
Printed
Name

Printed Name

Agency Head/Authorized Representative

Signature
Printed Name

Hon. Blesilda P. Almalbis

OR/Other Documents

JEV No.

Date