Republic of the Philippines

Department of Finance
BUREAU OF TREASURY - A5514
Office of the District/Chief Treasury Operations Officer II
Region IVA - CALABARZON
Address

To: THE MANAGER ATAP NO. 0421-2022-00405

PHILIPPINE VETERANS BANK
IMUS

AUTHORITY TO ACCEPT PAYMENT

FOR DEPOSIT TO SAVINGS ACCOUNT OF THE TREASURER OF THE PHILIPPINES
PAYING ORGANIZATION AREA CODE 0421
TANZANG LUMA IV (SOUTHERN CITY)
PAYING ORGANIZATION CODE 42109096 DATE PREPARED 04/21/2022
ADDRESS BILL NO. (YR-MONTH-NUMBER)
B-0421-202204-405
COMPUTATION OF FIDELITY BOND PREMIUM DUE
AMOUNT BOND
FUND CODE TRANSACTION CODE AMOUNT
(at 1.5% per annum / P 150.00)
03104344 4020219000 60,000.00 900.00

TOTAL AMOUNT PAYABLE 900.00

PREPARED BY: APPROVED BY:

DOFELIS, JOHN MICHAEL DANGARAN EGINA, GLORIA ANICO

ADMINISTRATIVE/TECHNICAL STAFF OIC-PROVINCIAL HEAD
Signature Over Signature Over
Printed Name and Position Printed Name and Position

FOR BANK USE ONLY

DETAILS OF PAYMENT
PARTICULARS DRAWEE BANK / NUMBER
CASH P
CHECK
TOTAL PAYMENT RECEIVED P
BANK MACHINE VALIDATION OF AMOUNT AND DATE