Republic of the Philippines

Provincial Government of Aklan

Kalibo, Aklan

No.

DISBURSEMENT VOUCHER

Mode of
Payment

Cas
h

Check

Others

TIN/ Employee No.

JEXTER N. PEREZ

Obligation Request
No.

448-411-810-000

Payee
Navitas Elementary
School
Numancia, Aklan

Responsibility Center: PGO

Office/Unit/Project
Code:

Address
EXPLANATION

AMOUNT

To payment for the salaries as Provincial School Board Teacher at Navitas

Elementary School, Numancia, Aklan for the month of April 1-15, 2015 in the amount of
-----

Php6,000.00
6,000.00

Certified:

Funds
available

Allotment obligated for the purpose as indicated

above
Supporting documents
complete
Signature

THERESA S.
TEMPLONUEVO
Provincial Accountant

Printed
Name
Position

Signature
Date:

Head, Acounting Unit /Authorized Representative

Printed Name
Position

Approved for Payment:

Date:

Provincial Treasurer
Treasurer/Authorized Representative

Received Payment:

Check No.

Signature

SUZETTE F. PIOQUID

Bank Name

Date:

Signature
Printed
Name

FLORENCIO T.
MIRAFLORES

Position

Provincial Governor

Date:

Agency Head /Authorized Representative

Printed Name
OR/Other
Documents

Date:
JVV No.

Date: