Appendix 33

PAYROLL
For the period Chalk Allowance 2016
Entity Name : San Policarpo NHS Payroll No. : _______________________
Fund Cluster : _______________________________ Sheet _________of __________Sheets
We acknowledge receipt of cash shown opposite our name as full compensation for services rendered for the period covered.

COMPENSATIONS DEDUCTIONS
Serial Employee Salaries and Gross Net Amount
Name Position Total Signature of Recipient
No. No. Wages- Amount Due
Deductions
Regular Earned
1 Desevel Rosalado 2,500.00 2,500.00
2 Rey Salomon 2,500.00 2,500.00
3 Allan Genes Alorro 2,500.00 2,500.00
4 Jojo Mendoza 2,500.00 2,500.00
5 Don Japet Baragenio 2,500.00 2,500.00
6 Jesabelle Labonite 2,500.00 2,500.00
7 Ma. Judy Gracia Tomnob 2,500.00 2,500.00
8 Ma. Teresa Maico 2,500.00 2,500.00
9 Joana Kristine Jeddah Torculas 2,500.00 2,500.00
10 Benson Ancheta 2,500.00 2,500.00
94

11 Gina Dean 2,500.00 2,500.00

12 Ma. Joan Villanueva 2,500.00 2,500.00
13 Shiela Catalan 2,500.00 2,500.00

TOTAL 32,500.00
A CERTIFIED: Services duly rendered as stated. C APPROVED FOR PAYMENT: _________________________________________________________________
_____________________________________________________________________(P )
ELIAS G. TOMNOB ELIAS G. TOMNOB
Signature over Printed Name of Authorized Date (Signature over Printed Name) Date
Official Head of Agency/Authorized
Representative

B CERTIFIED: Supporting documents complete and proper; and cash available in the D CERTIFIED: Each employee whose name appears on the payroll E
amount of P______________________. has been paid the amount as indicated opposite his/her name
ORS/BURS No. : _______________
Date : ____________________
MARY GRACE P. BALDOZA CHERRY MARIE FACUN JEV No. : _____________________
 (Signature over Printed Name) Date (Signature over Printed Name) Date : ____________________
Head of Accounting Division/Unit Disbursing Officer