Appendix

Appendix 11
OBLIGATION REQUEST AND STATUS Serial No. : _____________________
SOCORRO NATIONAL HIGH SCHOOL Date : _________________________

Entity Name Fund Cluster : 001
Payee
Office
Address
UACS Object
Responsibility Center Particulars MFO/PAP Amount
Code
70010916177 262003020500003
Total
Charges to appropriation/alloment
A. Certified: are B. Certified: Allotment available and obligated
necessary, lawful and under my direct supervision;a for the purpose/adjustment necessary as
supporting documents valid, proper and legal indicated above
Signature : ___________________________________ Signature : ______________________________
Printed Name: ____________________________________ Printed Name: ______________________________
Position : ____________________________________ Position : ______________________________

Head, Requesting Head, Budget Division/Unit/Authorized
Office/Authorized Representative Representative
Date : ___________________________________ Date : ____________________________
C. STATUS OF OBLIGATION
Reference Amount
Balance
ORS/JEV/Check/ Obligation Payable Payment Due and
Date Particulars Not Yet Due
ADA/TRA No. Demandable
(a) (b) (c) (a-b) (b-c)
42
Appendix 11
OBLIGATION REQUEST AND STATUS Serial No.:

Payee RUTH E. RUAYA

Office SOCORRO NATIONAL HIGH SCHOOL
Address SOCORRO, SURIGAO DEL NORTE
Responsibility UACS Object
Particulars MFO/PAP Amount
Center Code
TRAVELLING EXPENSES 302050002 380.00
Total 380.00
A. Certified: Charges to appropriation/alloment are B. Certified: Allotment available and obligated
necessary, lawful and under my direct supervision;and for the purpose/adjustment necessary as
Signature Signature : ______________________________

: _________________________________
Printed Name: ____DANTE S. DACERA_____________ Printed Name: ____GLORINA C. ERONG_____
Position Principal 1______________________ Position : ________Senior Bookkeeper______

:
Head, Requesting Head, Budget Division/Unit/Authorized
Office/Authorized Representative Representative
Date : ___________________________________ Date : ____________________________
Reference Amount
Balance
(a) (b) (c) (a-b) (b-c)
42
Appendix 11
Payee ADELINA S. CARDUZA
Center Code
70010916177 TRAVELLING EXPENSES 262003020500003 5020101000 340.00
Total 340.00
A. B.
Certified: Charges to appropriation/alloment are Certified: Allotment available and obligated
Signature
___________________________________ Signature : ______________________________
:
Position _____Senior Bookkeeper_____

Principal 1____ ____ Position : Head, Budget Division/Unit/Authorized
:
Representative
Date : ___________________________________ Date : ____________________________
Reference Amount
Balance
(a) (b) (c) (a-b) (b-c)
42
Appendix 11
Payee PATSULO L. CURAMBAO
Center Code
Total 340.00
A. B.
Signature
___________________________________ Signature : ______________________________
:

Principal 1________ Position : Head, Budget Division/Unit/Authorized
:
Representative
Date : ___________________________________ Date : ____________________________
Reference Amount
Balance
(a) (b) (c) (a-b) (b-c)
42
Appendix 11
Payee ANGELIE L. GAMUTAN
Center Code
Total 720.00
A. B.
Signature
___________________________________ Signature : ______________________________
:

Principal 1________ Position : Head, Budget Division/Unit/Authorized
:
Representative
Date : ___________________________________ Date : ____________________________
Reference Amount
Balance
(a) (b) (c) (a-b) (b-c)
42
42
Proposed
REPORT OF CHECKS ISSUED
01/28
Period Covered: ________________
2014-01-028
Agency : JDG Department Report No.: ___________
Fund : 01 1234
Bank Name/Account No. _________________ 1
Sheet No.: _______________
Check DV No. / ORS/BUR Responsibility UACS Code/
Payee MFO/PAP/KRA Amount
Date No. Payroll No. Center Code Expenditure
1/28 023 2014-02-010 010 26-036-00-00000 ABC Corporation 3 01 01 0000 50604050 03 44,000 00
123
44,000 00
CERTIFICATION
I hereby certify that this Report of Checks Issued (RCI) in _________ sheet(s) is a full,
true and correct statement of all checks issued by me in payment for obligations for the period stated and
shown in the attached disbursement vouchers.
AO 6/15/02
Juan dela Cruz 01/29/14

Disbursing Date
Officer

Appendix

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Appendix 11

OBLIGATION REQUEST AND STATUS Serial No. : _____________________

SOCORRO NATIONAL HIGH SCHOOL Date : _________________________

Signature : _____ Signature :

Printed Name: ______ Printed Name:

Position : ______ Position :

SOCORRO NATIONAL HIGH SCHOOL Date : _________________________

Payee RUTH E. RUAYA

TRAVELLING EXPENSES 302050002 380.00

Signature Signature : ______________________________

Printed Name: DANTE S. DACERA_____ Printed Name: GLORINA C. ERONG_

Position Principal 1________________ Position : Senior Bookkeeper

70010916177 TRAVELLING EXPENSES 262003020500003 5020101000 340.00

Printed Name: DANTE S. DACERA_____ Printed Name: GLORINA C. ERONG_

Position _Senior Bookkeeper_

70010916177 TRAVELLING EXPENSES 262003020500003 5020101000 340.00

Printed Name: DANTE S. DACERA_____ Printed Name: GLORINA C. ERONG_

Position _Senior Bookkeeper_

70010916177 TRAVELLING EXPENSES 262003020500003 5020101000 720.00

Printed Name: DANTE S. DACERA_____ Printed Name: GLORINA C. ERONG_

Position _Senior Bookkeeper_

Juan dela Cruz 01/29/14

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