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Agency CLASSIFICATION OF DISBURSEMENT Regular Cash Advance Other Payment MDS Check
No.: Date:
MODE OF PAYMENT Commercial Check
Cash
Others
NAME OF CLAIMANT:
ID No./TIN:
ROSALINDA H. BORJA
ADDRESS: Human Resource Management Service Particulars Reimbursement of Extraordinary and Representation Expense incurred by Dir. II, HRMS for the month of SEPTEMBER 2006 as per various receipts and other supporting documents hereto attached in the amount of TWENTY THREE THOUSAND THREE HUNDRED EIGHTY FIVE PESOS ONLY.. Breakdown: 883 Extraordinary Expense 783 Representation Expense Total 15,675.00 7,710.00 23,385.00 Responsibility Center:
Amount Due
A Certified: Expenses/Advances necessary lawful and incurred under my direct Supervision C Approved for payment D Received Payment: P ______________
TWENTY THREE THOUSAND THREE HUNDRED EIGHTY FIVE PESOS ONLY P 23,385.00 Amount
Bank Name:
ELISA C. NAVALTA
Head, Accounting Unit NCA No.: ALOBS No.: JEV No.: Date
al Check
Cash
Others
No./TIN:
sponsibility Center:
Amount
23,385.00
23,385.00
Received Payment: P ______________
___________________________ _____
V No.:
Date
SUMMARY OF EXPENSES
PAYEE
OR NO.
DATE
PLACE
TOTAL
This is to certify that the total amount indicated above was actually incurred by me in connection with the performance of my official duties and functions as Executive Director IV