Fund Cluster :

Date :
DISBURSEMENT VOUCHER DV No. :

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.

SCHOOL HEAD

B. Accounting Entry:
Account Title UACS Code Debit Credit

C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Supp
proper

Signature Signature

Printed
Printed Name
Name ELRIN ANN B. OROPESA EVA V. BESMONTE
School Bookkeeper
Position Position School Head

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
Cluster :

o. :

BURS No.:

Amount

Credit

NTE
 LIQUIDATION REPORT No.:
Department of Education, Division of Albay Date:
Agency Reponsibility Center:/Fund Source:
Organization Code: Location Code: Code:

PARTICULARS Amount

ACCOUNTING ENTRY
MFO ACCOUNT CODE DEBIT CREDIT

UNLIQUIDATED CASH ADVANCE, BEGINNING

CASH ADVANCE GRANTED PER DV No.
TOTAL UNLIQUIDATED CASH ADVANCE -
LESS LIQUIDATION REPORT:
TOTAL AMOUNT SPENT
REMITTANCE OF TAXES W/HELD PER OR #
TOTAL AMOUNT LIQUIDATED -
UNLIQUIDATED CASH ADVANCE, END 0.00
A Certified: Correctness of the B Certified: Purpose of travel/cash C Certified:Supporting documents complete
above data advance duly accomplished and proper

BEBIANO I. SENTILLAS RAFAEL B. TRAJANO

Claimant Schools Division Superintendent Division Accountant
Fund Source:

Amount

ents complete