Republic of the Philippines

QUEZON CITY GOVERNMENT

Quezon Memorial Circle, Diliman, Quezon City
NO.

DISBURSEMENT VOUCHER
Mode of
Payment

Check

Cash

Others

TIN/Employee No.

Payee

Obligation Request No.

Responsibility Center
Office/Unit/Project

Address

Code

EXPLANATION

AMOUNT

A. Certified

B. Certified

Allotment obligated for the purpose as

indicated above

Funds Available

Supporting documents complete

Signature

Signature

Printed Name EDITHA ALZONA

Position

Date

City Accountant

Printed Name VICTOR B. ENDRIGA

Position

City Accountant/ Authorized Representative

C.

Approved for Payment

Date

City Treasurer
City Treasurer/Representative

D. Received Payment
Check No.

Signature

Bank Name

Date

Signature
Printed Name HON. FELICIANO R. BELMONTE, JR.

Date

Position
City Mayor
City Mayor or City Administrator

Printed Name
OR/Other
Documents

Date
JEV No.

Date