Appendix 32

Republic of the Philippines Fund Cluster :

DEPARTMENT OF EDUCATION
Regional Office No. VIII
School Division of Northern Samar
PATICUA ELEMENTARY SCHOOL / Catarman I District Date :
School/Dsitrict DV No. :

DISBURSEMENT VOUCHER
Mode of MDS Check Commercial Check ADA Others (Please specify)
Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee

Address
Responsibility
Particulars MFO/PAP Amount
Center

Amount Due
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

ROBERTO RUBEN F. PULGA

School Head
B. Accounting Entry:
Account Title UACS Code Debit Credit
Traveling Expenses -Local 5020101000
Training Expenses 5020201000
Office Supplies Expenses 5020301000
Fuel, Oil and Lubricatants Expenses 5020309000
Other Supplies and Materials Expenses 5020399000
Electricity Expenses 5020402000
Telephone Expenses-Mobile 5020502001
Internet Subscription Expenses 5020503000
Cable, Satellite, Telegraph and Radio Expenses 5020504000
Printing and Publication Expenses 5029902000
Legal Services 5021101000
Janitorial Services 5021202000
Security Services 5021203000
Other General Services 5021299000
R & M School Building 5021304002
Food Expenses (School Feeding Program) 5021101000 `
C. Certified: D. Approved for Payment
Cash available
Subject to Authority to Debit Account (when applicable)
Supp

Signature Signature
Printed
MADONNA E. ACIBAR Printed Name ROBERTO RUBEN F. PULGA
Name
Senior Booker School Head
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Check/ Date : Bank Name & Account Number:
ADA No. :
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents

92
 Appendix 32
Republic of the Philippines Fund Cluster :
DEPARTMENT OF EDUCATION
Regional Office No. VIII
School Division of Northern Samar
CATARMAN SPED CENTER / Catarman I District Date :
School/Dsitrict DV No. :

DISBURSEMENT VOUCHER
Mode of MDS Check Commercial Check ADA Others (Please specify)
Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee

Address
Responsibility
Particulars MFO/PAP Amount
Center
PHOTO COPY AND BOOKBINDING OF
TIP MODULES SET

Amount Due
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

DIONESIA A. MERCADER
School Head
B. Accounting Entry:
Account Title UACS Code Debit Credit
Traveling Expenses -Local 5020101000
Training Expenses 5020201000
Office Supplies Expenses 5020301000
Fuel, Oil and Lubricatants Expenses 5020309000
Other Supplies and Materials Expenses 5020399000
Electricity Expenses 5020402000
Telephone Expenses-Mobile 5020502001
Internet Subscription Expenses 5020503000
Cable, Satellite, Telegraph and Radio Expenses 5020504000
Printing and Publication Expenses 5029902000
Legal Services 5021101000
Janitorial Services 5021202000
Security Services 5021203000
Other General Services 5021299000
R & M School Building 5021304002
Food Expenses (School Feeding Program) 5021101000 `
C. Certified: D. Approved for Payment
Cash available
Subject to Authority to Debit Account (when applicable)
Supp

Signature Signature
Printed
MADONNA E. ACIBAR Printed Name DIONESIA A. MERCADER
Name
Senior Booker School Head
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Check/ Date : Bank Name & Account Number:
ADA No. :
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents

92