Republic of the Philippines

Department of Finance

AGENCY NAME:___________________
AGENCY ADDRESS:_____________________________________________

ACCOUNTANTS ADVICE OF LOCAL

CHECK DISBURSEMENT

ADVICE NO. ____

DATE:
____________
To: The Bank Manager
Bank Branch
Bank Address
Please be informed that the following checks were issued by this office:
Bank Account
Number

TOTAL AMOUNT

Check
Number

Date

Payee

==========================================

Amount

Php ________

Amount in words

Certified Correct:

Disbursing Officer
(Signature Over Printed Name)

___________________________
Bank Representative
(Signature Over Printed Name)

Delivered by:
__________________________

Date Received:_______________________