Barangay Burgo

City/Municipality of Sta.Rosa
Province of Nueva Ecija

PUNONG BARANGAY’S CERTIFICATION (PBC)

PBC No. 14
Date: August 8, 2023
To: The Bank Manager
Land bank of the Philippines
Maharlika H-way, Cab.City

Sir/Madam:

This is to certify that the following checks were duly issued by Barangay Burgos
(Ito ay pagpapatunay na ang mga cheke na nakalista sa ibaba ay na-isyu sa Barangay Burgos

complete with respective Distribution Vouchers and supporting documents.

na kumpleto ang kanya-kanyang Distribution Vouchers at kalakip na mga dokumento.)

ACCOUNT No. Check no. Date Payee Amount Purpose

2752-1014-29 640005 08-08-2023 JOHN PAOLO FERNANDO 43,200.00 MEDICINE
640006 08-08-2023 EDNA LANDICHO 38,400.00 OTHER SUPPLIES

This is issued, pursuant to COA Circular 2019-3, dated March 22, 2019,
(itong ay patunay ay ginawa alinsunod sa COACircular 2019-3, na may petsang March 22 2019,

as a condition for the enashments of said checks.

bilang kundisyon para sa pagpapalit ng mga nasabing cheke.)

The undersigned attests to the truthfulness of the foregoing facts, under pain of
(pinapatotohanan ng my lagda ang mga nakasaad sa itaas, batid ang …

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

Very truly yours,

Rodolfo Mesina
Punong Barangay

Delivered by:
Receive by:

Mary Rose Diaz

Barangay treasurer Bank Representative

Date: ____________ Date: ____________