National Children's Hospital Fund Cluster :

Entity Name
1945 19 Date :
45
DISBURSEMENT VOUCHER DV No. :

Mode of
MDS Check Commercial Check ADA Others (Please specify)
Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee Philippine Records Management Association, Inc.

Address Los Baños, Laguna

Responsibility
Particulars MFO/PAP Amount
Center
Cash advance to defray expenses for attending seminar
and workshop entitled: "Records Management Alert: Protect
Your Record and Yourself," on September 16 - 18, 2019
in Cebu City
.

Itenirary of Travel
Invitation Letter
Airfare Canvass
HPO
Invitation Letter

.
Amount Due Php1
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

MORIEL DJ. CREENCIA, MD, FPPS

CHIEF OF MEDICAL PROFESSIONAL STAFF II
B. Accounting Entry:
Account Title UACS Code Debit Cred

C. Certified: D. Approved for Payment

Cash available

Subject to Authority to Debit Account (when applicable)

Fvat (5%/1.12)
Supp

Signature Signature

Printed
Name ESPERANZA C. DIESTO, CPA Printed Name EPIFANIA S. SIMBUL, MD, FPPS,C
Accountant IV Medical Center Chief II
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representa
Date Date
E. Receipt of Payment JEV No.
Check/ Date : Bank Name & Account Number:
ADA No. :
Date : Printed Name: Date
Signature :
Official Receipt No. & Date/Other Documents
uster :

_______
RS No.:

Amount

11320.00

Php11,320.00

Credit

D, FPPS,CEO VI
Chief II
d Representative