Appendix 11

OBLIGATION REQUEST AND STATUS Serial No. : _____________________

Date : _________________________
_____BUREAU OF FIRE PROTECTION R7____
Entity Name Fund Cluster : ___________________

Payee
FO2 Roland R Refugio
Office Valencia Fire Station

Address Catug-an, Valencia, Bohol

Responsibility UACS
MFO/PAP Amount
Center Object Code

To replenish PCF for 3rd Quarter CY 2022

Other supporting documents hereto

attached in the total amount…..
Total -
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: SINSP ALVIN A TORION Printed Name: SFO4 Joan V Dayapdapan

Position Chief, RLOG DIVISION Position : Chief, BUDGET SECTION

:
Head, Requesting Office/Authorized Representative Head, Budget Division/Unit/Authorized
Representative
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)
 Appendix 32

BUREAU OF FIRE PROTECTION Fund Cluster :

REGION 7 101
Date :
DISBURSEMENT VOUCHER DV No. :

Mode of MDS Check Commercial Check ADA Others (Please specify)

Payment
_________________

Payee FO2 Roland R Refugio TIN/Employee No.: ORS/BURS No.:

Address Catug-an, Valencia, Bohol

Responsibility
Particulars MFO/PAP Amount
Center

To replenish PCF for 3rd Quarter CY 2022

Other supporting documents hereto

attached in the total amount…..
Amount Due
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

SFO2 Lemuel S Bustamante

Municipal Fire Marshal

B. Accounting Entry:
Account Title UACS Code Debit Credit

Petty Cash 1-01-01-020

Cash - (MDS), Regular 1-01-04-040

C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Supp
proper

Signature Signature

Printed
FO1 Jonalyn G Baidiango, CPA Printed Name CSUPT JAIME D RAMIREZ, DSC
Name
OIC, Regional Accounting Office Regional Director
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative

Date Date

E. Receipt of Payment JEV No.

Check/ Date : Bank Name & Account Number:
ADA No. :
Signature : Date : Printed Name: Date

Official Receipt No. & Date/Other Documents

92