No.

Date:
Fund:

Payee
Office
Address
Account
Responsibility Center Particulars P.P.A. Amount
Code

A Certified: Charges to appropriation/allotments B Certified: Allotments available and obligated

necessary, lawful and under my direct supervision and for the purpose/adjustment necessary as indicated
supporting documents valid, proper and legal. below.

Signature: Signature:
Printed Name: Printed Name:
Position: Position:
Date: Date:
C STATUS OF OBLIGATION
Reference AMOUNT
Date: ORS No. JEV No. Obligation Payment Payable Balance
- -

No.
Date:
Fund:

Payee
Office
Address
Account
Responsibility Center Particulars P.P.A. Amount
Code

San Fernando Campus

Total Php -
A Certified: Charges to appropriation/allotments B Certified: Allotments available and obligated
necessary, lawful and under my direct supervision and for the purpose/adjustment necessary as indicated
supporting documents valid, proper and legal. below.

Signature: Signature:
Printed Name: Printed Name:
Position: Position:
Date: Date:
C STATUS OF OBLIGATION
Reference AMOUNT
Date: ORS No. JEV No. Obligation Payment Payable Balance
0 - -