Republic of the Philippines

Department of Health
BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER
Baguio City
Form No.: FS-BUD-001
OBLIGATION REQUEST AND STATUS
Revision No.: 01
BUDGET UTILIZATION REQUEST AND STATUS
Effectivity Date: July 1, 2015

Payee: No:

Office: Date:

Address: Fund:
Responsibility
Particulars MFO/PAP UACS Code Amount
Center

Total -
A Certified: Charges to appropriation/allotment necessary, B Certified: Allotment available and obligated for the
lawful and under my direct supervision; and supporting purpose / adjustment necessary as indicated above.
documents valid, proper and legal.
Signature: Signature:
Printed Name: EDWARD C. PUDLAO, CPA,MBA Printed Name: EDNA L. MOGAMOG, CPA,MBA
Position: Financial & Management Officer II Position: Supervising Administrative Officer
Head, Budget Office
Date: December 26, 2023 Date: December 26, 2023

C STATUS OF OBLIGATION
Reference Amount
ORS/BURS/JEV/RCI/ Due and
Date Particulars RADAI No.
Obligation/Utilization Payment Not Yet Due
Demandable
Totals