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Annex A

PROVINCE/CITY/MUNICIPALITY

ACCOUNTANT'S ADVICE OF LOCAL


CHECK DISBURSEMENT

Date

To: The Bank Manager

(Account No.)

Voucher No. Payee Amount

etc.

Total Amount
Amount in Words

Certified Correct: Delivered by:

Bookkeeper Accountant's Representative


(Signature over Printer Name) (Signature over Printer Name)

Approved by: Received by:

Prov./City/Mun. Accountant Bank Representative


(Signature over Printer Name) (Signature over Printer Name)

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