Republic of the Philippines Department of Finance BUREAU OF TREASURY - AS514 Office of the DistrictIChief Treasury Operations Officer i Region X - Northen Mindanao ‘Address: Jo. THE MANAGER ATAP NO___1035-2022-01026_ LAND BANK OF THE PHILIPPINES. _ILIGAN _ JUIGAN CITY AUTHORITY TO ACCEPT PAYMENT FOR DEPOSIT TO SAVINGS ACCOUNT OF THE TREASURER OF THE PHILIPPINES [PAYING ORGANIZATION ‘AREA CODE 1035 |SANOOR (DADUAN} PAYING ORGANIZATION CODE __ 103502025 Joxta rreranen 32222072 ADDRESS BARANGAY SANDOR (DADUAN), BALO!, LANAO DEL [BILL NO. (YR-MONTH-MUMBER) NORTE 8-1035-202212-1026 COMPUTATION OF FIDELITY BOND PREMIUM DUE “AMOUNT BOND Fun cope | TRANSACTION CODE (at 1.5% per annum | P 150.00) ae es10a344 "4020213000 235,000.00 3,525.00 TOTAL AMOUNT PAVABLE: 3,525.00 TOTAL PAYMENT RECEIVED BANK MACHINE VALIDATION OF AMOUNT AND DATEONCOLT PAYMENT SLIP : Date LAND BANK OF THE PHILIPPINES ONCOLL PAYMENT SLIP el { wns hh tw Please check the appropriate mode of payment. [om ee ieee WERCHANT/AGENCY DEPOSIT ACCOUNT NUMBER MERCHANWAGENCY NAME Burton oF the SHOT ENTS 4) St beebty wend gare treasury Reference Number 1 Printed Name and Signature of Payor/Depositor/Representative 3 llOOLO%OOOID 5 Reference Number 2 [Jeru3 Reference Number 3 (Numeric) r2¢ LYN -P_ EBC + 14850, Amount This is your receipt when machine validated TTP AL BA Van re we eT