BILLING STATEMENT

___________________
Date

The School Head

______________________________
_________________, Northern Samar

Relative to the Contract I entered into the ___________________________________________

Dated _______________, I would like to request for the partial/full payment of the ________________
Services/s I rendered in your school in the amount of ________________________________________
(Php ______________).

Respectfully yours,
_____________________

Inspected By:

________________________

Designated Inspector

ACKNOWLEDGEMENT RECEIPT
_________________

This is to acknowledge the partial/full payment I received from the ________________________in the amount of
___________________________________________ (Php ____________________) for the

______________________________________________________ I rendered as demanded and stipulated in the

Pakyaw contract dated ____________________________.

Received By:

________________________

Witnessed By:

_________________________

Designated Supply Officer