Appendix 39

SIMONE HIGH SCHOOL

(Entity Name)

ADVICE OF CHECKS ISSUED AND CANCELLED

To: The Bank Manager ACIC No. 0023
Land Bank of the Philippines Organization Code:
Kabacan, Cotabato Fund Cluster: MOOE
Bank Account No. 2732-1089-90 Area Code:
Date: APRIL 22, 2024 NCA No.

CHECK NO. DATE PAYEE AMOUNT UACS OBJECT CODE FOR GSB USE ONLY
DATE NEGTD REMARKS
0001250645 04/23/2024 3GNF ENTERPRISES 26, 543.85
0001250646 04/23/2024 GGIT ENTERPRISES 2, 400.00

TOTAL ACIC AMOUNT 28, 943.85

Amount in Words: Twenty Eight Thousand and Nine Hundred Forty-Three and Eighty Five Centavos
Total No. Of Checks: 2
Only
 Appendix 39

CANCELLED CHECKS Certified Correct by: Received by:

CHECK NO. DATE ISSUED REMARKS
JACK A. MACABATAL ___________________________
Signature Over Printed Name Signature Over Printed Name of the GSB
Disbursing Officer Personnel who received the ACIC

Approved by: Delivered by:

MAANO A. KADINGILAN ___________________________

Signature Over Printed Name Signature Over Printed Name of Agency
Head of Office Personnel who delivered the ACIC to the
GSB

REPORT SUMMARY
No. Of ACIC 2
(s)
Grand Total 28, 943.85
Amount in Words Twenty Eight Thousand and Nine Hundred Forty-Three and Eighty Five Centavos Only

Certified Correct by: Received by:

JACK A. MACABATAL ___________________________

Signature Over Printed Name Signature Over Printed Name of the GSB
Disbursing Officer Personnel who received the ACIC

Approved by: Delivered by:

MAANO A. KADINGILAN JACK A. MACABATAL

Signature Over Printed Name Signature Over Printed Name of Agency
Head of Office Personnel who delivered the ACIC to the GSB