CERTIFICATION

Name of Fuel Station: ________________________ Ref. No. 2023-06-0001

DATE PRODUCTS PLATE/VEHICLE NO. OF UNIT AMOUNT

(DSL/GAS) NO. LITERS PRICE
6/14/2023 DSL Engine 1 45 65.24 2,935.80

(fuel station personnel)

Signature over Printed
Name

Pls read:

 This form shall be used or attached KUNG WALAY CHARGE INVOICE ang Fuel
Station every time mag utang mo ug Diesel or Gasoline;

 Take note SIGNATURE OVER PRINTED NAME sa taga Fuel station jud, not only
signature or name dapat BOTH;

 The REFERENCE NO. sample 2023-06-0001 stands for YEAR-MONTH-SERIES NO.;

 Therefore the following will be your complete documentary requirements:

 Purchase Request
 Canvass Proposal (2k and above)
 Abstract of Canvass (2k and above)
 Purchase Order
 Charge Invoice/Certification (sample above)
 Fuel Consumption
 Trip Tickets
 Report of Official Travel
 Report of Fuel Consumption
 AFOR(Fire Incidents/Call)
 After Activity Response Report(Ambulance)
 BILLING STATEMENT

Name of Fuel Station: ________________________

DATE REF. NO. PRODUCTS PLATE/ NO. OF UNIT AMOUNT

(DSL/GAS) VEHICLE NO. LITERS PRICE
6/14/2023 2023-06-0001 DSL Engine 1 45 65.24 2,935.80
6/15/2023 2023-06-0002 GAS Ambulance 35 62.21 2,177.91

TOTAL 5,113.71

(fuel station personnel)

Signature over Printed
Name

Pls read:

 This form shall be prepared and attached upon PREPARATION OF PCV ready for
payment sa total fuel nga inyo giutang for issuance of Official Receipt/Sales Invoice and
other forms as proof of payment by the fuel station;

 Therefore in every PCV prepared the following shall be your complete documentary
requirements:

 Petty Cash Voucher

 Billing Statement
 Official Receipt/Sale Invoice and;
 All Charge Invoices/Certifications with the attachments previously
prepared