Republic of the Philippines

DEPARTMENT OF EDUCATION
DepED - Region III
Nueva Ecija
Organizational Code (UACS): 070010803004
OBLIGATION REQUEST AND STATUS No.:
DepED-Division of Nueva Ecija Date:
Agency
Payee RAUL P. STA INES
Office BARANGKA ES
Address SAN ISIDRO, NUEVA ECIJA
Particulars TO CASH ADVANCE THE MOOE DOWNLOADING FOR THE MONTH OF JUNE 2017

Responsibility Account Name Fund Source MFO/P.P.A. Account Code Amount

Center

FINANCIAL ASSISTANCE TO NGA's 1101101 261003020500002 5021402000 10,754.75

Total 10,754.75
A. Certified B. Certified
Charges to appropriation / allotment necessary, lawful Allotment available and obligated for the purpose

and under my direct supervision as indicated above

Supporting documents valid, proper and legal

Signature Signature

Printed Name RONALDO A. POZON, Ph.D., CESO V Printed Name SARAH S. REGALA
Schools Division Superintendent Administrative Officer V
Position Position
Head, Requesting Office/Authorized Representative Head, Budget Unit/ Authorized Representative

Date Date
C STATUS OF OBLIGATION
.
Reference Amount
Date ORS No. JEV No. Obligation Payment Payable Balance