Annex “A-1”

Republic of the Philippines

PROVINCE OF ZAMBOANGA SIBUGAY
Municipality of Siay

PUNONG BARANGAY’S CERTIFICATION (PBC)

(FOR BARANGAY CHECK DISBURSEMENT)

PBC No. _18______

Date : October 28, 2019
To : The Bank Manager
LAND BANK OF THE PHILIPPINES
IPIL BRANCH
IPIL, ZAMBOANGA SIBUGAY

Sir/Madam:
This is to certify that the following checks were duly issued by Barangay Siloh
(ito ay pagpapatunay na ang mga cheke na nakalista sa ibaba ay na- isyu ng Barangay Siloh)

Complete with respective Disbursement Voucher and supporting documents.

(Na kumpleto ng kanya-kanyang Disbursement Voucher at kalakip ng mga Dokumento)
Bank Account No. Check No. Date Payee Amount Purpose
1252-1019-30 1240816 10/28/2019 ALRICH ALBARICO 4,367.00 FIDELITY BOND
1252-1019-30 1240817 10/28/2019 JUMARY BASING 3,280.00 FIDELITY BOND

TOTAL 7,647.00
Amount in Words Seven Thousand Six Hundred forty Seven Pesos Only

This certification is issued, pursuant to COA circular 2018-001, dated 1-30-2018

(ito patunay ay ginawa alinsunod sa COA Circular 2018-001, na may petsang 1-30-2018)

As a condition for the encashment of said checks

(Bilang kondisyon para sa pagpapalit ng mga nasabing cheke)

The undersigned attests to the truthfulness of the foregoing facts, under pain of
(pinapatotohanan na may lagda ang mga nakasaad sa itaas, batid ang)

Liability for falsification, pursuant to Article 171(4) of the Revised Penal Code
(Pananagutan sa kasong “Falsification,” sang-ayon sa Article 1714(4) ng Revised Penal Code)

Very truly yours,

HON. NELCY D. KLING

Punong Barangay

Delivered by: Received by:

LEIA V. OMANDAM
Barangay Treasurer/Representative Bank Representative
Date : _______________________ Date:___________________________