Appendix 31

Sheet 1 of 1 Sheets

DAILY WAGE PAYROLL

HOSPITAL SERVICES
PROJECT
BPH - MARAMAG Period : December 1-31, 2016

Number Rate Gross Net Signature or Community Tax Certificate RJEB and OBRE
Deductions
Name Designation of Days Per
Salary Late Pay Thumb Mark Number Date
Worked Day w/ Tax Pag ibig MTRY
(Min) UNDERTIME
2 Bansiloy, Genevieve Luz A, MD Med Officer III 22 1,974.50 43,439.00 200.00 25.00 - 43,214.00 2 5284.92 37929.080

1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
TOTAL PAGE 43,439.00 0.00 200.00 25.00 0.00 43,214.00 5284.92
43,214.00
CERTIFIED: Approved for Payment: CERTIFIED:
Each person whose name appears on this roll had Each person whose name appears on the
rendered services for the time stated. above roll has been paid the amount stated opposite
his name after identifying him.
JOSEPHINE A. DUROG, REA EDMUNDO G. GARCIA, MD,FPSGS, FPCS
Administrative Officer I
_____________________________________ Chief of Hospital II
__________________________________ ___________________________________
Name and Signature of Approving Officer Name and Signature of Disbursing Officer
43,439.00
#VALUE!

43,439.00
 PROVINCE OF BUKIDNON

REQUEST FOR JOURNAL ENTRY VOUCHER (R-JEV) November 28, 2016

A. PARTICULARS/DETAILS / COMPUTATIONS AMOUNT REQUESTED BY

CLAIMANT: 43,439.00
Bansiloy, Genevieve Luz, MD
EDMUNDO G. GARCIA, MD,FPSGS, FPCS
NATURE OF PAYMENT : Salaries and Wages of Chief of Hospital II
BPH-Maramag Job Order personnel for December 1-31,
2016 Representative
B. ATTACHED DOCUMENTS (to be accomplished by ICD)
PRE-AUDITED BY
Description Code Document No. Date

C. PRO-FORMA JE (to be accomplished by the Accounting Division PRE-JEV

ACCOUNT TITLE Code DR CR

JEVER

JEV REVIEW

JEV APPROVED

D. CHECK NO. DATE ISSUED BANK ACCOUNT NO.

CHECKLIST OF ATTACHMENTS (to be accomplished by the concerned office)

SALARIES & WAGES

Obligation Request

Daily Time Record

Disbursement Voucher

DTR

NOTE : This form must be accomplished in 3 copies

GENERAL FORM No. 6
Revised January 1992

SUMMARY OF PAYROLLS
HOSPITAL SERVICES
Project
Agency BPH - MARAMAG: Period : December 1-31, 2016
AMOUNT UNPAID
PAYROLL NUMBER AMOUNT OF ROLLS AMOUNT PAID ON ROLLS
ON ROLLS
As of 2 sheets 43,214.00
ADD; Pag ibig 200.00
Mortuary 25.00
Withholding Tax -

43,439.00

TOTALS 43,439.00
Prepared by: GLEEN MARK G. DIMATULAC Certified Correct: JOSEPHINE A. DUROG, REA
Administrative Aide III Administrative Officer I

ACCOUNTING ENTRY

ACCOUNT CODE DEBIT CREDIT CERTIFIED CORRECT

____________________________
Accountant
 Republic of the Philippines
Province of Bukidnon
Provincial Capitol 8700

OBLIGATION REQUEST No.:

Payee: Bansiloy, Genevieve Luz, MD

Office: BPH Maramag

Address: Maramag, Bukidnon

Responsibility Account
PARTICULARS F.P.P. Amount
Center Code

Salary of Job Order Employees for the period

Maramag December 1-31, 2016 4422 969 43,439.00

Total - - - 43,439.00

A. Certified:
Charges to appropriation/allotment necessary, B. Certified:
lawful and under my direct supervision
Existence of available appropriation
Supporting documents valid, proper and legal

Signature: Signature:

Printed Printed
EDMUNDO G. GARCIA, MD,FPSGS, FPCS FE C. RETUERTAS
Name: Name:
Provincial Budget Officer
Position: Chief of Hospital II Position:
Head, Budget Unit / Authorized Representative

Date: November 28, 2016 Date:

 Republic of the Philippines
PROVINCIAL GOVERNMENT OF BUKIDNON
Provincial Capitol

NO.
DISBURSEMENT VOUCHER
Mode of
Check Cash Others
Payment
TIN/Employee No. Obligation Request No.
Payee Bansiloy, Genevieve Luz, MD
RESPONSIBILITY CENTER
Address Maramag, Bukidnon Office/Unit/Project Code

EXPLANATION AMOUNT

Payment of BPH-Maramag Job Order Employees for the Period 43,214.00

December 1-31, 2016

A Certified: B Certified:
Allotmant obligated for the purpose as
indicated above. Funds Available

Supporting documents completed.

Signature Signature

Printed Date Printed Date

RICHEL R. OKIT, CPA, MBA MARILOU S. BUENO, CPA
Name Name
Provincial Accountant ICO - Provincial Treasurer
Position: Position:
Head, AccountingUnit/Authorized Representative Treasurer/Authorized Representative

C Approved for Payment D Received Payment

Check No. Bank Name Date
Signature

Printed
Signature
Name
Printed
Position:
Agency Head/Authorized Representative Name
OR/Other documents JEV NO. Date