Annex A

Republic of the Phillippines

PROVINCIAL GOVERNMENT OF NUEVA VIZCAYA
Bayombong, Nueva Vizcaya
No.
OBLIGATION REQUEST
Payee

Office

Address
Responsibility Account
Particulars F.P.P Amount
Center Code

Total
A. Certified B. Certified
Charges to appropriation/allotment necessary, lawful Existence of available appropriation
and under my direct supervision
Supporting documents valid, proper and legal

Signature Signature
Printed
Printed Name
Name

Position Position
Head, Requesting Office/Authorized Representative Head, Budget Unit/Authorized Representative
Date Date
 OBLIGATION REQUEST (ObR)
INSTRUCTIONS

A. The Obligation Request shall be prepared in 7. F.P.P. – code for function/program/project

three copies, to be distributed as follows: as shown in the approved appropriation/
Original – to be attached to the DV allotment
Duplicate – Budget Unit 8. Account Code – expense/asset/liability
Triplicate – Accounting Unit account code where the obligation shall be
charged
B. The Budget Unit shall stamp the date of receipt
on the face of this form. 9. Amount – amount of obligation/
adjustment
C. This form shall be accomplished in the 10. Certified (Box A) – Certification by the
following manner: Head of the Requesting Office or his
1. No. – number assigned to the Obligation authorized representative on the necessity
Request by the Budget Unit or its equivalent. and legality of charges to the
The numbering shall be as follows: appropriation/allotment under his direct
supervision, and validity, propriety and
00 – 0000 – 00 – 0000 legality of supporting documents
The certifying officer shall affix his
signature, print his name, indicate his
Serial number (one series position, and the date of his signing on the
for each year) spaces provided.
Month
Year
Allotment Class
11. Certified (Box B) – Certification by the
Head of the Budget Unit or his authorized
2. Payee – name of payee or creditor representative on the existence of available
appropriation.
3. Office – name of the office of payee or
creditor The certifying officer shall affix his
signature, print his name, indicate his
4. Address – address or location of the office of position, and the date of his signing on the
the payee or creditor spaces provided.
5. Responsibility Center – code of the cost
center where expenses shall be charged D. Any correction/adjustment by the Accounting
6. Particulars -- brief description of the Unit which will require the corresponding
obligation requested adjustment in the appropriate RAAO shall be
coordinated with the Budget Unit.

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