Appendix 11

Department of Agriculture Serial No. : _____________________

Bureau of Fisheries and Aquatic Resources- VII Date :

OBLIGATION REQUEST AND STATUS Fund Cluster : MDS FUND 101/01101101

Payee KIM M. MONTERONA

Office BFAR -7
Address Cebu City
UACS Object
Responsibility Center Particulars MFO/PAP Amount
Code

Reimbursement of incurred expenses durng the official travel in Negros Oriental and Carmen, Cebu 4,350.00
as per supporting documents hereto attached in the total amount of…………………………

Total 4,350.00
A. Certified: Charges to appropriation/alloment are B. Certified: Allotment available and obligated
necessary, lawful and under my direct supervision;and for the purpose/adjustment necessary as
supporting documents valid, proper and legal indicated above

Signature : ___________________________________ Signature : ______________________________

Printed Name : IONNE ELENA C. VILLAGONZAL Printed Name: MA. VICTORIA D. PEÑA

Position : Regional Director Position : OIC, Budget Section

Date : ___________________________________ Date : ____________________________

C. STATUS OF OBLIGATION
Reference Amount
Balance

ORS/JEV/Check/ Obligation Payable Payment Due and

Date Particulars Not Yet Due
ADA/TRA No. Demandable

(a) (b) (c) (a-b) (b-c)

 Proposed
REPORT OF CHECKS ISSUED
01/28
Period Covered: ________________
2014-01-028
Agency : JDG Department Report No.: ___________
Fund : 01 1234
Bank Name/Account No. _________________ 1
Sheet No.: _______________
Check DV No. / ORS/BUR Responsibility UACS Code/
Payee MFO/PAP/KRA Amount
Date No. Payroll No. Center Code Expenditure
1/28 023 2014-02-010 010 26-036-00-00000 ABC Corporation 3 01 01 0000 50604050 03 44,000 00
123

44,000 00

CERTIFICATION
I hereby certify that this Report of Checks Issued (RCI) in _________ sheet(s) is a full,
true and correct statement of all checks issued by me in payment for obligations for the period stated and
shown in the attached disbursement vouchers.
AO 6/15/02

Juan dela Cruz 01/29/14

Disbursing Date
Officer