REPUBLIKA NG PILIPINAS

(REPUBLIC OF THE PHILIPPINES)

KAGAWARAN NG EDUKASYON
(DEPARTMENT OF EDUCATION)
Region VII, Central Visayas
DIVISION OF CEBU PROVINCE

DISBURSEMENT VOUCHER
MODE OF PAYMENT

MDS Check Commercial Check ADA /' Others

Name of Payee:LECSEM'S FASHION & ACCESSORIES TIN/Employee No. OS/ BUS No:
TIN: 930-626-702-000 2022-07-0001
Responsibility Center

Address: Poblacion, Samboan Cebu Title: Code:

Particulars Amount
ü
To payment of communication allowance of Paquito S. Itao for the month of August 2022 in the amount of ….
1,000.00

Fill up details for salary claim. PAQUITO S. ITAO

FIRST DAY OF SERVICE: ü School Principal
BIRTH DATE: ü
GSIS BP NO.: ü
PHILHEALTH NO.: ü
PAG-IBIG NO.:ü
TAX IDENTIFICATION NUMBER:ü
Amount Due 1,000.00
A B Approved for
Certified: Supporting documents complete and proper Payment: .

Cash Advance One Thousand Only. (P1,000.00)

Subject to ADA (where applicable

Signature: __________________________________________ Signature : _______________________________________________

Printed Name: _ PAQUITO S. ITAO

Printed Name: __________________________________________
Position: ___________________________________________ Position: School Principal
_______________________________________________
(Authorized Representative) (Agency Head/Authorized Representative)

Date: ___________________________________________ Date: _______________________________________________

Received Payment: Check/ADA No: _________________ Journal Entry:Voucher:

C D
Date: _________________________ No.: __________________
Signature: Date: Bank Name: ____________________ Date: __________________

_____________ DR No./other relevant document _____

LECSEM'S FASHION & ACCESSORIES Issued: ________________________