Appendix 32

Fund Cluster :

Republic of the Philippines

Department of Public Works and Highways
Camarines Sur 3rd District Engineering Office
Caraycayon, Tigaon Camarines Sur

Date :
DV No. :

DISBURSEMENT VOUCHER
Mode of
Payment

MDS Check

Commercial Check

ADA

_________________
ORS/BURS No.:

TIN/Employee No.:

JM-COFER CONSTRUCTION AND SUPPLY

Payee

Others (Please specify)

LBP-3761-0048-23

220-696-426-000

1022015-12-000153

Zone 1 No. 107 Bagumbayan Norte, Naga City

Address

Particulars

Responsibility Center

MFO/PAP

Amount

2014-4-01. Buildings and Other Structures 268004010100201.PC

Second Partial Collection due to the above-named creditor for furnishing and delivering labor and
materials for CY 2015 BASIC EDUCATIONAL FACILITIES FUND (BEFF), SENIOR HS PROG.
CONST. OF 2 STOREY 4 CL W/ CR BURABOD, GARCHITORENA, CAMARINES SUR as per
approved supporting papers hereto attached in the amount of.......
Contract Amount
P
6,571,875.14
37.00%
2,431,368.94
Less: Previous collection
1,683,517.85
Total value of work this billing
747,851.09
Less: 10% Retention Fee
74,785.11
Recoupment of 15% Mobilization
140,227.39
Amount this billing
532,838.59
Less: Witholding Taxes
P
G.A./1.12X5% VAT
23,787.44

G.A./1.12X2% WHT
9,514.97
33,302.41
Net Amount
P
499,536.18
15FF0047
50314900342
Amount Due
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

499,536.18

499,536.18

LARRY D. MORENO
PROJECT ENGINEER II

B. Accounting Entry:
Account Title

UACS Code

Debit

Credit

D. Approved for Payment

C. Certified:
Cash available

Four Hundred Ninety Nine Thousand Five Hundred Thirty Six Pesos
18/100

Subject to Authority to Debit Account (when applicable)

Supp
proper
Signature

Signature

Printed Name
Position

Printed Name

RUEL B. BONGULTO
Chief Accountant

Position

Head, Accounting Unit/Authorized Representative

Date
E. Receipt of Payment

GEMMA B. TIMBANG
District Engineer
Agency Head/Authorized Representative

Date
JM-COFER CONST. & SUPPLY

JEV No.

Check/ ADA
No. :

Date :

Bank Name & Account Number:

Signature :

Date :

Printed Name:

Official Receipt No. & Date/Other Documents

92

Date

Appendix 32
Republic of the Philippines
Department of Public Works and Highways
Camarines Sur 3rd District Engineering Office
Caraycayon, Tigaon Camarines Sur

Fund Cluster :

Date :
DV No. :

DISBURSEMENT VOUCHER
Mode of
Payment

MDS Check

Payee

Commercial Check

ADA

Others (Please specify)

_________________
ORS/BURS No.:
1022015-12-000153

TIN/Employee No.:

Bureau of Internal Revenue

220-696-426-000

Tigaon Camarines Sur

Address

Particulars

Responsibility Center
MFO/PAP
2014-4-01. Buildings and Other Structures268004010100201.PC

Amount

33,302.41

33,302.41

To remit the 2% w/ tax and 5% VAT of JM COFER CONSTRUCTION and SUPPLY from
Second Partial Payment for CY 2015 BASIC EDUCATIONAL FACILITIES FUND (BEFF),
SENIOR HS PROG. CONST. OF 2 STOREY 4 CL W/ CR BURABOD, GARCHITORENA,
CAMARINES SUR as per approved supporting papers hereto attached in the amount of.......
Contract Amount
Tax Base
Less:
G.A./1.12x5% VAT
G.A./1.12x2% WHT

P
P

6,571,875.14
1,258,798.56

23,787.44
9,514.97
33,302.41

15FF0047
50314900342
Amount Due
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.
LARRY D. MORENO
PROJECT ENGINEER II

B. Accounting Entry:
Account Title

UACS Code

C. Certified:
Cash available

Debit

Credit

D. Approved for Payment

Thirty Three Thousand Three Hundred Two Pesos 41/100

Subject to Authority to Debit Account (when applicable)

Supp
proper
Signature
Printed Name
Position

Signature
Printed Name

RUEL B. BONGULTO
Chief Accountant
Head, Accounting Unit/Authorized Representative

Position

Date
E. Receipt of Payment
Check/ ADA
No. :

GEMMA B. TIMBANG
District Engineer
Agency Head/Authorized Representative

Date
JM-COFER CONST. & SUPPLY

Signature :

JEV No.

Date :

Bank Name & Account Number:

Date :

Printed Name:

Official Receipt No. & Date/Other Documents

92

Date