Signatories

HEAD OF REQUESTING OFFICE

Name
Position

HEAD OF PROVINCIAL BUDGET OFFICE

Name
Position

HEAD OF PROVINCIAL TREASURER'S OFFICE

Name
Position

HEAD OF ACCOUNTANT'S OFFICE / AUTHORIZED REPRESENTATIVE

Name
Position

LOCAL CHIEF EXECUTIVE / AUTHORIZED REPRESENTATIVE

Name
Position
 Signatories
REQUESTING OFFICE
HON. ROSALINA G. JALOSJOS
Provincial Governor

PROVINCIAL BUDGET OFFICE

MARY JOY A. ABITONA
Provincial Budget Officer

PROVINCIAL TREASURER'S OFFICE

JESSIA A. CONCEPCION
Provincial Treasurer

ACCOUNTANT'S OFFICE / AUTHORIZED REPRESENTATIVE

MARIVIC SU. CARPITANOS
Provincial Accountant

HIEF EXECUTIVE / AUTHORIZED REPRESENTATIVE

HON. ROSALINA G. JALOSJOS
Provincial Governor
Proceed to DATA ENTRY FORM >>>
 DATA ENTRY
PAYEE INFORM
PAYEE JOHN VINCENT G. ESTRELLA

PAYEE's OFFICE COA

PAYEE's ADDRESS

PAYEE's ID NO. / TIN

FUND AND RESPONSIB
FUND GF - Proper (01)

RESPONSIBILITY CENTER 09-7200-01-1000-1011 GOVERNOR'S OFFIC

TRANSACTION PAR
Reimbursement of Fuel Expenses

PARTICULARS

AMOUNT AND D
Function Code Allotment Class
1011 GOVERNOR'S OFFICE 200 (MOOE)
 DATA ENTRY FORM
PAYEE INFORMATION
. ESTRELLA

FUND AND RESPONSIBILITY CENTER

1011 GOVERNOR'S OFFICE

TRANSACTION PARTICULARS
Fuel Expenses

AMOUNT AND DETAILS

Account Code
50203090 Fuel, Oil and Lubricants Expenses
 Responsibility Center
<<<Edit SIGNATORIES!
09-7200-01-1000-1011

See CAFOA 09-7200-01-1000-1012

See FURS 09-7200-01-1000-1016

See DV 09-7200-01-1000-1017

09-7200-01-1000-1018

09-7200-01-1000-1994
09-7200-01-1000-1994-(01)

09-7200-01-1000-1999

09-7200-01-1000-1999-1999(01)

09-7200-01-1000-1999-1999(02)

RC

09-7200-01-1000-1011

Amount 09-7200-01-1000-1999-1999(05)

P 12,595.25 09-7200-02-1021

09-7200-02-1022

09-7200-03-1031

09-7200-03-1032

09-7200-04-1041

09-7200-04-1061
 Republic of the Philippines
Province of Zamboanga del Norte DISBURSEMENT VOUCHER (DV) TEMPLATES
PROVINCIAL ACCOUNTANT'S OFFICE in conformance with the Government Accounting Manual (GAM) for LGUs promulgated by the Commission on Audit (COA)

Here is a list of all the DV templates included in this excel file.

Click the name of the transaction below to proceed to its DV template.
HOW TO FILL OUT THE DV?(click here to read the INSTRUCTIONS)
1 1st & Monthly Regular Salary
2 Salary Differentials
3 Salary Casual/Contractual
Professional Services
Note:
4
5 Monetization
6
7
Terminal Leave
Overtime Pay
DV templates provided herein
8 Loyalty Cash Award, or Incentive should be printed on long
9 Maternity Leave (8.5 x 13) size bond paper.
10 General Claims thru ATM
11 RATA
12 Cloting / Uniform Allowance DV templates with more than
13 Hazard, Subsistence & Laundry one (1) page should be printed
14 Honoraria
15 Mid-Year Bonus back to back.
16 PS Conso
17 Postage and Stamps
18 Petty Cash Fund (PCF)
19 All Cash Advances Except For Travels
 Province of Zamboanga del Norte
CERTIFICATION ON APPROPRIATIONS, FUNDS
AND OBLIGATION OF ALLOTMENT
(CAFOA)

Obligation No.
Request Reimbursement of Fuel Expenses

(Particulars)
Approved Amount: P 12,595.25

Payee: JOHN VINCENT G. ESTRELLA Certification:

Allotment Account I hereby certify as to the existence of appropriations

Function Amount
Class Code for the expenditures in the amount specified herein:
1011 200 50203090 P 12,595.25

MARY JOY A. ABITONA

Provincial Budget Officer Date

Certification:

Total amount requested P 12,595.25 I hereby certify as to the availability of funds for the
expenditures in the amount specified herein:
Amount in Words:
TWELVE THOUSAND FIVE HUNDRED NINETY-FIVE & 25/100
PESOS ONLY
JESSIA A. CONCEPCION
Provincial Treasurer Date
Requesting Official:
Certification:

HON. ROSALINA G. JALOSJOS I hereby certify that the allotments are available for
Provincial Governor obligation in the amount specified herein:
Name and Signature

MARIVIC SU. CARPITANOS

Date Provincial Accountant Date

Subsidiary Ledger

Obligation Increase
Date Particulars / Reference Liquidations Balance
(Decrease)
 FUND UTILIZATION REQUEST AND STATUS FURS No. : ______________
PROVINCE OF ZAMBOANGA DEL NORTE Date : ___________________
Fund : TRUST FUND

Payee JOHN VINCENT G. ESTRELLA

Office COA
Address
F.P.P. Particulars Account Code Amount
1011 Reimbursement of Fuel Expenses 50203090 P 12,595.25

Total P 12,595.25
A. Certified: Charges to special trust account necessary, B. Certified: Funds available and utilized for
lawful and under my direct supervision; and supporting the purpose/adjustment necessary as
documents valid, proper and legal indicated above

Signature : __________________________________ Signature : ____________________________

Printed Name: HON. ROSALINA G. JALOSJOS Printed Name: MARIVIC SU. CARPITANOS

Position : Provincial Governor Position : Provincial Accountant

Head, Requesting Office/Authorized Representative Head, Accounting Division/Unit/ Authorized
Representative

Date : _______________________________ Date : ____________________________

C. STATUS OF UTILIZATION
Reference Amount
Balance
FURS/JEV/RCI/ Utilization Payable Payment Due and
Date Particulars Not Yet Due
RADAI No. Demandable
(a) (b) (c) (a-b) (b-c)
 DISBURSEMENT VOUCHER Fund: GF - Proper (01)

Province of Zamboanga del Norte DV No.:

Provincial Capitol, Dipolog City Date:
ID No./TIN:
Payee: JOHN VINCENT G. ESTRELLA
CAFOA No.:
Responsibility Center:
Address:
09-7200-01-1000-1011

Particulars Amount
Reimbursement of Fuel Expenses
P 12,595.25

A Certified:
Expenses/Cash Advances necessary, valid,
proper, lawful and incurred under my direct
supervision.
Amount Due P
B Certified: C Certified:
Completeness and propriety of supporting Funds available for the purpose.
documents marked check (ü) per checklist
provided herein/previous cash advance
liquidated or accounted for/existence of funds
held in trust.

HON. ROSALINA G. JALOSJOS MARIVIC SU. CARPITANOS JESSIA A. CONCEPCION

Provincial Governor Provincial Accountant Provincial Treasurer
Head of the Department or Office Head of Accounting Department / Head of Treasury Department /
Authorized Representative Authorized Representative

D Approved For Payment: P________ E Received Payment:

D Payment:
D
Check No. _______________
Bank Name: ______________
HON. ROSALINA G. JALOSJOS Date: ___________________
Provincial Governor Signature Over Printed Name/Position
Local Chief Executive / Authorized Representative Date_________________________

F Accounting Entries
Particulars / Account Title Account Code Debit Credit

Please see attached separate sheet.

FOR ACCOUNTING / PRE-AUDIT PERSONNEL USE ONLY:

CHECKLIST: MANDATORY MINIMUM SUPPORTING DOCUMENTS FOR COMMON TRANSACTIONS per COA Circular 2012-001,
CSC Circulars, DBM Circulars, BIR Revenue Regulations, RA 7160, COA Audit Observation Memoranda, and Issuances from
other Government Regulating Agencies.
Supporting Documents for Maintenance and Other Operating Expenses
Reimbursement of other reimbursements (Fuel)
Official Receipt
Trip Ticket
Purchase Request
PPMP
Others
Reviewed by:

Accounting/Pre-Audit Date

Page 10 of 80
Republic of the Philippines
Province of Zamboanga del Norte DISBURSEMENT VOUCHER (DV) TEMPLATES
PROVINCIAL ACCOUNTANT'S OFFICE in conformance with the Government Accounting Manual (GAM) for LGUs promulgated by the Commission on Audit (COA)

BACK TO DV
INSTRUCTIONS
(Appendix 31 of the GAM for LGUs)

A. The DV is a form used to pay an obligation to employees/individuals/agencies/creditors for goods purchased or services rendered. It shall be prepared by the Requesting Office/Unit. The
Accounting Division/Unit shall stamp on the face of this form the date of receipt from the requesting unit.

B. This form shall be accomplished as follows:

1.       LGU – name of the local government unit
2.       Fund – the fund name in which the disbursement should be charged
3.       DV No. – number assigned to the DV by the Accounting Division/Unit. It shall be numbered as follows:

0000-00-0000

Serial Number (one series for each year)

Month Month
Year  
Year

4.       Date – date of preparation of the DV

5.       Payee – name of the payee/creditor
6.       Address – address of the claimant
7.       TIN/Employee No. – Tax Identification Number (TIN) of the claimant/Identification Number assigned by the agency to the officer/employee
8.       CAFOA No. – the serial number of the CAFOA supporting the DV
9.       Responsibility Center (Office/Unit/Project and Code) – the office/unit/project and code assigned to the cost center where the disbursement shall be charged.
10.   Particulars – brief description of the disbursement
11.   Amount – amount of claim
12.   Certified (Box A) – certification by the Head of the Department or Office who has administrative control of the fund as to necessity, validity, propriety and legality of the claim involved.
13.   Certified (Box B) – certification by the Head of Accounting Department/Office as to the completeness and propriety of the supporting documents. In case of cash advance, that the accountable
officer has no unliquidated cash advances. In case of trust funds, certification as to the existence of the trust account.
14.   Certified (Box C) – certification by the Head of Treasury Department/Office or his/her authorized representative as to availability of funds for the purpose.
The certifying officer shall affix his/her signature and indicate his/her name and position/designation, and the date of signing on the spaces provided.
15.   Approved for Payment (Box D) – approval by the Head of the Agency or his/her Authorized Representative on the payment covered by the DV.
The approving officer shall affix his/her signature and indicate his/her name and position/designation, and the date of signing on the spaces provided.
16.   Receipt of Payment (Box E) – acknowledgment by the claimant or his/her duly authorized representative for the receipt of the check/ADA/cash and the date of receipt. The claimant/payee shall
affix his/her signature and date of receipt on the space provided and shall indicate the number and the date of the check, bank name and account number, and OR number and date other relevant
documents issued to acknowledge the receipt of payment.

17.   Accounting Entries (Box F) - accounting entries provided for the transaction. The Particulars will present the gist of the transaction and the title of the account used. The Account Code of the
account title. The Debit and Credit show the amount of the transaction. The Preparer of the accounting entries and the Certifying Officer as to the correctness of the accounting entries shall sign the
appropriate spaces provided.

C. The DVs shall be prepared in four (4) copies to be distributed as follows:

Original - COA, through Accounting Division/Unit together with the supporting documents for submission to the Auditor for post audit
Copy 2 - Cash Treasury/Unit
Copy 3 - Accounting Division/Unit
Copy 4 - Payee
Republic of the Philippines
Province of Zamboanga del Norte CAFOA TEMPLATE
PROVINCIAL ACCOUNTANT'S OFFICE in conformance with the Government Accounting Manual (GAM) for LGUs promulgated by the Commission on Audit (COA)

INSTRUCTIONS
(Appendix 28 of the GAM for LGUs)

A.     The CAFOA shall be prepared by the head of the requisitioning office/unit.

B.      It shall be supported with payrolls, purchase request, etc.

C.      This form shall be accomplished as follows:

·         The Head of the Department making the request shall sign the Request portion; the Budget Officer shall sign the certification as to the existence of
appropriations; the Treasurer, as to the availability of funds; and the Accountant, as to the obligation of allotment.

·         The Accountant shall assign a number to each CAFOA in the following manner:
i.      Serial Number (4 digits) --------------- 0000
ii.      Month (2 digits )------------------------- 00
iii.      Year (2 digits) ------------------------- 00
iv.      Fund Code (3 digits) ------------------ 000

·         Posting to the registries/subsidiary

Monthledgers shall be made by the Accounting Unit. Any excess certification shall be adjusted by posting the amount in the
 
credit column in parenthesisYear to bring the balance to zero.

·         CAFOAs which have been fully liquidated or with zero balances shall be filed separately from those with unliquidated CAFOAs.

D.     It shall be accomplished in six copies to be distributed as follows:

·         Original – Budget Officer

·         Duplicate – attached to the disbursement voucher
·         1 copy – to COA, thru Accounting Office
·         1 copy – to the Accounting Office
·         1 copy – to the Treasurer’s Office
·       1 copy – to the Requesting Office
 F. P. P. S E A
This is a Searchbox for the Function/Program/Project (F.P
Please type in the Searchbox be

Note: Only the Function Code is entered on the "Fun

SEARCH account

SEARCH
Function Code Acronym
1081 ACCTG
9996 SUB Special
 F. P. P. S E A R C H B O X
he Function/Program/Project (F.P.P.) of the Provincial Government of Zamboanga del Norte.
Please type in the Searchbox below to search for a Function Code.

ction Code is entered on the "Function" Column at the Request Portion of the CAFOA.

Search by:

SEARCH RESULTS
Description
PROVINCIAL ACCOUNTANT
SUBSIDY TO OTHER SPECIAL ACCOUNTS
 OX
al Government of Zamboanga del Norte.
unction Code.

the Request Portion of the CAFOA.

Description

S
<<<Back to DATA ENTRY FORM

Description
Nth
GOVERNOR'S OFFICE
PROVINCIAL WARDEN
OFFICE OF THE VICE GOVERNOR
PROVINCIAL INTERNAL AUDIT OFFICE
PROVINCIAL DISASTER RISK REDUCTION & MGT. OFFICE
MISCELLANEOUS GENERAL PUBLIC SERVICES
PEACE AND ORDER AND PUBLIC SAFETY
OTHER EXECUTIVE SERVICES
ZAMBOANGA DEL NORTE TECHNOLOGY AND LIVELIHOOD DEVEL
ZAMBOANGA DEL NORTE CONVENTION AND EXHIBITION CENTER
ZAMBOANGA DEL NORTE SWIMMING POOL
ZAMBOANGA DEL NORTE CULTURAL AND SPORTS CENTER
ZN COOPERATIVE
SP-LEGISLATIVE
SP-SECRETARIAT
PROVINCIAL ADMINISTRATOR'S OFFICE
PROVINCIAL HUMAN RESOURCE MANAGEMENT OFFICE
PROVINCIAL PLANNING AND DEVELOPMENT OFFICE
PROVINCIAL GENERAL SERVICES OFFICE
PROVINCIAL BUDGET
PROVINCIAL ACCOUNTANT
PROVINCIAL TREASURER
REAL PROPERTY TAX ADMINISTRATION
PROVINCIAL ASSESSOR
REAL PROPERTY TAX MAPPING
COMMISSION ON AUDIT
PROVINCIAL INFORMATION CENTER/NBN 11
PROVINCIAL LIBRARY
PROVINCIAL ATTORNEY
PROVINCIAL PROSECUTOR
COC-RTC AREA 1-DIPOLOG
COC-RTC AREA 2-SINDANGAN
RTC BRANCH 27-SIOCON
RTC BRANCH 28-LILOY
REGISTER OF DEEDS
PUBLIC EDUCATION
SPORTS DEVELOPMENT
OTHER EDUCATION, SPORTS & MANPOWER DEVELOPMENT SERV
PROVINCIAL HEALTH OFFICE
HOSPITAL
LABASON DISTRICT HOSPITAL
LILOY INTEGRATED HEALTH DISTRICT HOSPITAL
TRIFON SAILE MEMORIAL HOSPITAL
PIÑ AN DISTRICT HOSPITAL
SERGIO OSMEÑ A SR. MUNICIPAL HOSPITAL
SIBUTAD MUNICIPAL HOSPITAL
SINDANGAN DISTRICT HOSPITAL
SIBUCO MUNICIPAL HOSPITAL
ZAMBOANGA DEL NORTE MEDICAL CENTER
REPAIR AND MAINTENANCE OF GOV'T. FACILITIES - HEALTH
PURCHASE, CONSTRUCTION AND IMPROV'T. OF GOV'T. FACILITIES
OTHERS - LDF HEALTH
LILOY HEALTH DISTRICT MANAGEMENT TEAM
SIOCON BIRTHING CLINIC
HEALTH CARE
OTHER HEALTH SUPPORT SERVICES AND PROGRAMS
PROVINCIAL SOCIAL WELFARE AND DEVELOPMENT OFFICE
LOCAL DEVELOPMENT FUND-SOCIAL
NUTRITION DEVELOPMENT PROGRAM
LIVELIHOOD/EMPLOYMENT PROGRAM
PROVINCIAL POVERTY REDUCTION INITIATIVES
EDUCATIONAL ASSISTANCE-OUT-OF SCHOOL YOUTH
OTHERS - LDF SOCIAL
OTHERS - SOCIAL
ASSISTANCE TO FAMILY IN CRISIS SITUATION
PRODUCTIVITY SKILLS CAPACITY BUILDING CENTER
WOMEN'S WELFARE PROGRAM
PERSONS WITH DISABILITY PROGRAM
SENIOR CITIZEN'S PROGRAM
FAMILY WELFARE PROGRAM
CHILD PROTECTION PROGRAM
CHILD WELFARE PROGRAM
YOUTH WELFARE PROGRAM
POPULATION MANAGEMENT PROGRAM
OTHER PROGRAM
PROVINCIAL AGRICULTURIST OFFICE
PROVINCIAL VETERINARIAN'S OFFICE
PROVINCIAL ENVIRONMENT & MANAGEMENT OFFICE
PROVINCIAL ENGINEERING OFFICE
PROVINCIAL TOURISM OFFICE
LOCAL DEVELOPMENT FUND-ECONOMIC
AGRICULTURAL DEVELOPMENT PROJECT -LDF ECONOMIC
TOURISM PROJECTS - LDF ECONOMICS
INDUSTRIAL DEVELOPMENT PROJECT- LDF ECONOMICS
REPAIR & MAINTENANCE OF GOV'T. FACILITIES - LDF ECONOMICS
PURCHASE, CONSTRUCTION & IMPROVEMENT OF GOV'T. FACILITI
OTHER ECONOMIC SERVICES PROJECTS - LDF
MISCELLANEOUS ECONOMIC SERVICES
MAINTENANCE/OPERATION OF AGRICULTURAL PROGRAM, LIVES
COUNTERPART FUND
CONSTRUCTION/IMPROVEMENT/REHABILITATION OF PRIORITY
LOAN AMORTIZATION(DOMESTIC)-LDP
INTEREST PAYMENT(DOMESTIC)-LDP
LOAN AMORTIZATION(DOMESTIC)-REGULAR
INTEREST PAYMENT(DOMESTIC)-REGULAR
LUMPSUM APPROPRIATIONS
DISASTER RICK REDUCTION AND MGT.
RELIEF AND RECOVERY
PREPAREDNESS AND MITIGATION-MOOE
PREPAREDNESS AND MITIGATION-CO/INFRA.
PREMIUMS ON CALAMITY INSURANCE
SUBSIDY TO NATIONAL GOVERNMENT AGENCIES
SUBSIDY TO LGUs
SUBSIDY TO OTHER SPECIAL ACCOUNTS
SUBSIDY TO NGOs/POs
BUDGETARY RESERVES
OTHERS
DONATION
LOCAL SPECIAL BODIES
AGRICULTURAL COOPERATIVE DEVELOPMENT INTERNATIONAL
DEPT. OF AGRICULTURE
DEPT. OF AGRARIAN REFORM-WESTERN MINDANAO COMMUNITY
DIPOLOG DAPITAN POLANCO KATIPUNAN ROXAS & MANUKAN
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DEPARTMENT OF THE INTERIOR AND LOCAL GOV'T.
DEPT. OF FINANCE - MUN. DEV'T. FUND OFFICE
DEPARTMENT OF HEALTH
DEPT. OF LABOR AND EMPLOYMENT
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
OFFICE OF THE PRESIDENTIAL ADVISER ON THE PEACE PROCESS
PHILLIPINE HEALTH INSURANCE CORPORATION-PHILHEALTH CA
TRAVELING EXPENSES
FOOD SUPPLIES EXPENSES
WELFARE GOODS EXPENSES
DRUGS AND MEDICINES EXPENSES
MEDICAL, DENTAL AND LABORATORY SUPPLIES EXPENSES
OTHER SUPPLIES AND MATERIALS EXPENSES
PRINTING AND PUBLICATION SERVICES
REPRESENTATION EXPENSES
RENT EXPENSES
OTHER MAINTENANCE AND OPERATING EXPENSES
Republic of the Philippines
Province of Zamboanga del Norte FURS TEMPLATE
PROVINCIAL ACCOUNTANT'S OFFICE in conformance with the Government Accounting Manual (GAM) for LGUs promulgated by the Commission on Audit (COA)

INSTRUCTIONS
(Appendix 29 of the GAM for LGUs)

A.    The FURS shall be prepared by the requisitioning office administering the trust receipts and the Local Accountant shall certify as to availability of funds. FURs shall be posted in the
Registry of Special Trust Fund.

B.     The report shall be accomplished as follows:

1.  LGU – name of the local government unit
2.  FURS No. – number assigned to the FURS for control purposes which shall be as follows:

0000– 00 –0000
Serial number (one series for each year)
Month
Year

3.  Date – date of the FURS

4.  Fund – name of fund
5.  Payee – Name of payee or creditor
6.  Office – office of the payee/creditor
7.  Address – office address of the payee/creditor
8.   Project – project/purpose where expenses shall be charged
9.   Particulars – brief description of the utilization requested for
10.  Account Code – the appropriate account code according to the RCA
11.  Amount – Amount of utilization
12.  Box A – Certification by the Head of Requesting Office/Authorized Representative Charges to special trust fund is necessary and lawful; and supporting documents are
valid, proper and legal.
13.  Box B – Certification by the Head of Accounting Division/Unit/Authorized Representative that funds are available and utilized for the purpose.

C.   This form shall be prepared in three (3) copies to be distributed as follows:

Original – Accounting Division/Unit

Copy 2 – to be attached to the DV
Copy 3 – Requesting Office
 ALLOTMENT
Note: Only the Allotment Class Code is entered on the "Allotment C

Code

100 (PS)
200 (MOOE)
300 (CO)
 ALLOTMENT CLASS
ment Class Code is entered on the "Allotment Class" Column at the Request Portion of the CAFOA.

Description

Personnel Services
Maintenance and Other Operating Expenses
Capital Outlay
<<<Back to DATA ENTRY FORM
 ACCOUNT CODE
This is a Searchbox for the Account Codes and Account Titles listed in

Please type in the Searchbox below to s

Note: Only the Account Code is entered on the "Account Code"

SEARCH TRAVEL

SEARCH RESULT
Account Code Account Title
50201010 Traveling Expenses - Local
50201020 Traveling Expenses - Foreign
 NT CODE SEARCHBOX
t Codes and Account Titles listed in the Chart of Accounts in the GAM for LGUs by COA.

se type in the Searchbox below to search for an Account.

s entered on the "Account Code" Column at the Request Portion of the CAFOA.

Search by: Account Title

SEARCH RESULTS

ocal
oreign
<<<Back to DATA ENTRY FORM

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