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Annex B

Republic of the Philippines

DEPARTMENT OF EDUCATION
DepED Complex, Meralco Avenue, Pasig City
No.

DISBURSEMENT VOUCHER
MDS Check

Mode of
Payment

Commercial Check

ADA

TIN/Employee No.

Others

OR/BUR No.

Payee
Responsibility Center
Office/Unit/Project

Address

Code

EXPLANATION

A. Certified

AMOUNT

B. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Supporting documents complete

Signature

Signature

Printed
Name

Printed
Name

Position

Head, Accounting Unit/Authorized Representative

Position

Head, Accounting Unit/Authorized Representative

Date

Date

C. Received Payment

JEV No.

Check/
ADA No.

Date

Bank Name

Signature

Date

Printed Name

Official Receipt/Other Documents

Agency Head/Authorized Representative

Agency Head/Authorized Representative

Date