Republic of the Philippines Fund Cluster :

DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS

ZAMBOANGA DEL SUR
1ST DISTRICT ENGINEERING OFFICE Date :
REGIONAL OFFICE IX
Pagadian City
DV No. :

DISBURSEMENT VOUCHER
Mode of MDS Check Commercial Check ADA Others (Please Specify)
Payment
ORS/BURS No.:
Payee JZL BUILDERS AND ENTERPRISES

TIN/Employee No.:
Address PAGADIAN CITY

Responsibility
Particulars MFO/PAP Amount
Center
15% Advance Payment for the Basic Infrastructure Program (BIP)
Improvement of Road, Barangay Salvador, Dumingag, Zamboanga
Del Sur undertaken by contract with JZL Builders & Enterprises
represented by Jay Russell R. Lidres

Advance Payment P 2,954,211.63

Less: 2% EWT 52,753.78
5% EVAT 131,884.45 184,638.23
Net Amount Due 2,769,573.40

Contract ID: 22JE0055

Contract Amount: 19,694,744.21
ORS No.:
FCR Current

Computation of Taxes
2% EWT ( - / 1.12) *0.02 52,753.78
5% EVAT ( - / 1.12) *0.05 131,884.45
Total 184,638.23
Amount Due 2,769,573.40
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

JUDITH J. BAHIAN
Engineer III
Chief, Construction Section

B. Accounting Entry
Account Title UACS Code Debit Credit

C. Certified D. Approved for Payment

Cash Available
Subject to Authority to Debit Account (When Applicable)
Sup
Proper

Signature Signature
Printed
Printed Name
RYAN A. CAMOGAO Name BENSALI A. KASIM
Accountant III District Engineer
Position Position
Chief, Finance Section Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date Bank Name and Account Number
No.
Date Printed Name
Signature
Date
Official Receipt No. and Date/Other Documents
 Republic of the Philippines Fund Cluster :
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
ZAMBOANGA DEL SUR
1ST DISTRICT ENGINEERING OFFICE Date :
REGIONAL OFFICE IX
Pagadian City
DV No. :

DISBURSEMENT VOUCHER
Mode of MDS Check Commercial Check ADA Others (Please Specify)
Payment
ORS/BURS No.:
Payee xxxx

TIN/Employee No.:
Address xxxx
xxxx
Responsibility
Particulars MFO/PAP Amount
Center
Payment for the First Partial Billing of xxxx% Work Accomplished for the
project title undertaken by contract with xxxx represented by xxxx

Cost this Billing P xxx

Less: 15% Advance Payment xxx
2% EWT xxx
5% EVAT xxx
10% Retention xxx xxx
Net Amount Due xxx

Contract ID: xxxx

Contract Amount: xxxx
ORS No.:
FCR Current/PY

Computation of Taxes
2% EWT ( xxx / 1.12) *0.02 xxxx
5% EVAT ( xxx / 1.12) *0.05 xxxx
Total xxxx
Amount Due xxx
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

xxx
Engineer III
Chief, Construction Section

B. Accounting Entry
Account Title UACS Code Debit Credit

C. Certified D. Approved for Payment

Cash Available
Subject to Authority to Debit Account (When Applicable)
Sup
Proper

Signature Signature
Printed
Printed Name
RYAN A. CAMOGAO Name BENSALI A. KASIM
Accountant III District Engineer
Position Position
Chief, Finance Section Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date Bank Name and Account Number
No.
 Date Printed Name
Signature
Date
Official Receipt No. and Date/Other Documents
 Republic of the Philippines+A1:AN26A19A1:AN25 Fund Cluster :
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
ZAMBOANGA DEL SUR
1ST DISTRICT ENGINEERING OFFICE Date :
REGIONAL OFFICE IX
Pagadian City
DV No. :

DISBURSEMENT VOUCHER
Mode of MDS Check Commercial Check ADA Others (Please Specify)
Payment
ORS/BURS No.:
Payee xxxx

TIN/Employee No.:
Address xxxx
xxxx
Responsibility
Particulars MFO/PAP Amount
Center
Payment for the First Partial Billing of xxxx% Work Accomplished for the
project title undertaken by contract with xxxx represented by xxxx

Cost this Billing P xxx

Less: 15% Advance Payment xxx
Tax Base xxx
Less: 2% EWT xxx
5% EVAT xxx
10% Retention xxx xxx
Net Amount Due xxx

Contract ID: xxxx

Contract Amount: xxxx
ORS No.:
FCR Current/PY

Computation of Taxes
2% EWT ( xxx / 1.12) *0.02 xxxx
5% EVAT ( xxx / 1.12) *0.05 xxxx
Total xxxx
Amount Due xxx
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

xxx
Engineer III
Chief, Construction Section

B. Accounting Entry
Account Title UACS Code Debit Credit

C. Certified D. Approved for Payment

Cash Available
Subject to Authority to Debit Account (When Applicable)
Sup
Proper

Signature Signature
Printed
Printed Name
RYAN A. CAMOGAO Name BENSALI A. KASIM
Accountant III District Engineer
Position Position
Chief, Finance Section Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date Bank Name and Account Number
No.
 Date Printed Name
Signature
Date
Official Receipt No. and Date/Other Documents
 Republic of the Philippines Fund Cluster :
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
ZAMBOANGA DEL SUR
1ST DISTRICT ENGINEERING OFFICE Date :
REGIONAL OFFICE IX
Pagadian City
DV No. :

DISBURSEMENT VOUCHER
Mode of MDS Check Commercial Check ADA Others (Please Specify)
Payment
ORS/BURS No.:
Payee xxxx

TIN/Employee No.:
Address xxxx
xxxx
Responsibility
Particulars MFO/PAP Amount
Center
Payment for the First Partial Billing of xxxx% Work Accomplished for the
project title undertaken by contract with xxxx represented by xxxx

Cost this Billing P xxx

Less:
2% EWT xxx
5% EVAT xxx
10% Retention xxx xxx
Net Amount Due xxx

Contract ID: xxxx

Contract Amount: xxxx
ORS No.:
FCR Current/PY

Computation of Taxes
2% EWT ( xxx / 1.12) *0.02 xxxx
5% EVAT ( xxx / 1.12) *0.05 xxxx
Total xxxx
Amount Due xxx
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

xxx
Engineer III
Chief, Construction Section

B. Accounting Entry
Account Title UACS Code Debit Credit

C. Certified D. Approved for Payment

Cash Available
Subject to Authority to Debit Account (When Applicable)
Sup
Proper

Signature Signature
Printed
Printed Name
RYAN A. CAMOGAO Name BENSALI A. KASIM
Accountant III District Engineer
Position Position
Chief, Finance Section Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date Bank Name and Account Number
No.
 Date Printed Name
Signature
Date
Official Receipt No. and Date/Other Documents
 Republic of the Philippines Fund Cluster :
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
ZAMBOANGA DEL SUR
1ST DISTRICT ENGINEERING OFFICE Date :
REGIONAL OFFICE IX
Pagadian City
DV No. :

DISBURSEMENT VOUCHER
Mode of MDS Check Commercial Check ADA Others (Please Specify)
Payment
ORS/BURS No.:
Payee SEVERS CONSTRUCTION & SUPPLIES & REALTY DEVELOPMENT
TIN/Employee No.:
Address

Responsibility
Particulars MFO/PAP Amount
Center
Payment for the Third Billing of 90.00% Work Accomplished for the
Construction/Improvement of Access Roads Leading to Declared Tourism
Dest. NRJ Leading to Simata Adventure Park, Brgy. Simata, Molave,
Zamboanga del Sur undertaken by contract with SEVERS CONSTRUCTION &
SUPPLIES & REALTY DEVPT. represented by SEVERINO A. TAN.

Cost to Date P 13,092,356.83

Less: Previous Billing 10,039,853.87
Cost this Billing 3,052,502.96
Less: 15% Advance Payment 457,875.44
Tax Base
Less: 2% EWT 54,508.98
5% EVAT 136,272.45
10% Retention 152,625.15
Liquidated Damages -
Net Amount Due 2,251,220.94

Contract ID: 21JE0075

Contract Amount: 14,341,660.62
ORS No.:
FCR Current/PY

Computation of Taxes
2% EWT ( 3,052,502.96 / 1.12) *0.02 54,508.98
5% EVAT ( 3,052,502.96 / 1.12) *0.05 136,272.45
Total 190,781.44
Amount Due 2,251,220.94
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

JUDITH J. BAHIAN
Engineer II
Acting Chief, Construction Section

B. Accounting Entry
Account Title UACS Code Debit Credit

C. Certified D. Approved for Payment

Cash Available
Subject to Authority to Debit Account (When Applicable)
Sup
Proper

Signature Signature
Printed
Printed Name
RYAN A. CAMOGAO Name BENSALI A. KASIM
Accountant III District Engineer
Position Position
Chief, Finance Section Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date Bank Name and Account Number
No.
Date Printed Name
Signature
Date
Official Receipt No. and Date/Other Documents
 Republic of the Philippines Fund Cluster :
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
ZAMBOANGA DEL SUR
1ST DISTRICT ENGINEERING OFFICE Date :
REGIONAL OFFICE IX
Pagadian City
DV No. :

DISBURSEMENT VOUCHER
Mode of MDS Check Commercial Check ADA Others (Please Specify)
Payment
ORS/BURS No.:
Payee ZMS CONSTRUCTION & DEVELOPMENT CORP.
TIN/Employee No.:
Address PAGADIAN CITY

Responsibility
Particulars MFO/PAP Amount
Center
Payment for the 5th Partial Billing of 90.01 % Work Accomplished for
the Construction of Concrete Road, Construction of NRJ Bulanit Leading to
Coastal Road, Bulanit, Labangan, Zamboanga del Sur undertaken by
contract with ZMS CONSTRUCTION & DEVELOPMENT CORP.
represented by JESUS A. MANIAGO

Cost to Date P 27,575,770.18

Less: Previous Billing 22,826,836.80
Cost this Billing 4,748,933.38
Less: 15% Advance Payment 712,340.01
Tax Base
Less: 2% EWT 84,802.38
5% EVAT 212,005.95
10% Retention 474,893.34

1,484,041.68
Net Amount Due 3,264,891.70

Contract ID: 21JE0036

Contract Amount: 30,633,700.00
ORS No.:
PY

Computation of Taxes
2% EWT ( 4,748,933.38 / 1.12) *0.02 84,802.38
5% EVAT ( 4,748,933.38 / 1.12) *0.05 212,005.95
Total 296,808.34
Amount Due 3,264,891.70
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

JUDITH J. BAHIAN
Engineer II
Chief, Construction Section

B. Accounting Entry
Account Title UACS Code Debit Credit

C. Certified D. Approved for Payment

Cash Available
Subject to Authority to Debit Account (When Applicable)
Sup
Proper

Signature Signature
Printed
Printed Name RYAN A. CAMOGAO BENSALI A. KASIM
Name
Accountant III District Engineer
Position Position
Chief, Finance Section Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date Bank Name and Account Number
No.
Date Printed Name
Signature
Date
Official Receipt No. and Date/Other Documents
 Republic of the Philippines Fund Cluster :
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
ZAMBOANGA DEL SUR
1ST DISTRICT ENGINEERING OFFICE Date :
REGIONAL OFFICE IX
Pagadian City
DV No. :

DISBURSEMENT VOUCHER
Mode of MDS Check Commercial Check ADA Others (Please Specify)
Payment
ORS/BURS No.:
Payee xxxx

TIN/Employee No.:
Address xxxx
xxxx
Responsibility
Particulars MFO/PAP Amount
Center
Payment for the xxxx Partial Billing of xxxx% Work Accomplished for the
project title undertaken by contract with xxxx represented by xxxx

Cost to Date P xxx

Less: Previous Billing xxx
Cost this Billing xxx
Less: 15% Advance Payment xxx
2% EWT xxx
5% EVAT xxx
10% Retention xxx
Liquidated Damages xxx xxx
Net Amount Due xxx

Contract ID: xxxx

Contract Amount: xxxx
ORS No.:
FCR Current/PY

Computation of Taxes
2% EWT ( xxx / 1.12) *0.02 xxxx
5% EVAT ( xxx / 1.12) *0.05 xxxx
Total xxxx
Amount Due xxx
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

xxx
Engineer III
Chief, Construction Section

B. Accounting Entry
Account Title UACS Code Debit Credit

C. Certified D. Approved for Payment

Cash Available
Subject to Authority to Debit Account (When Applicable)
Sup
Proper

Signature Signature
Printed
Printed Name
RYAN A. CAMOGAO Name BENSALI A. KASIM
Accountant III District Engineer
Position Position
Chief, Finance Section Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date Bank Name and Account Number
No.
Date Printed Name
Signature
 Date Printed Name
Signature
Date
Official Receipt No. and Date/Other Documents
 Republic of the Philippines Fund Cluster :
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
ZAMBOANGA DEL SUR
1ST DISTRICT ENGINEERING OFFICE Date :
REGIONAL OFFICE IX
Pagadian City
DV No. :

DISBURSEMENT VOUCHER
Mode of MDS Check Commercial Check ADA Others (Please Specify)
Payment
ORS/BURS No.:
Payee xxxx

TIN/Employee No.:
Address xxxx
xxxx
Responsibility
Particulars MFO/PAP Amount
Center
Withdrawal of 10% Retention for the project title undertaken by contract
with xxxx represented by xxxx

P xxx

Contract ID: xxxx

Contract Amount: xxxx
ORS No.:
FCR Current/PY

Amount Due xxx

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

xxx
Engineer III
Chief, Construction Section

B. Accounting Entry
Account Title UACS Code Debit Credit

C. Certified D. Approved for Payment

Cash Available
Subject to Authority to Debit Account (When Applicable)
Sup
Proper

Signature Signature
Printed
Printed Name
RYAN A. CAMOGAO Name BENSALI A. KASIM
Accountant III District Engineer
Position Position
Chief, Finance Section Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Check/ ADA Date Bank Name and Account Number
No.
Date Printed Name
Signature
Date
Official Receipt No. and Date/Other Documents