Republic of the Philippines

Department of Finance
BUREAU OF TREASURY - A5514
Office of the District/Chief Treasury Operations Officer II
Region VII - Central Visayas
Address

To: BRANCH MANAGER ATAP NO. 0712-2024-02116

LAND BANK OF THE PHILIPPINES
TAGBILARAN CITY HALL BRANCH
TAGBILARAN CITY, BOHOL

AUTHORITY TO ACCEPT PAYMENT

FOR DEPOSIT TO SAVINGS ACCOUNT OF THE TREASURER OF THE PHILIPPINES
PAYING ORGANIZATION AREA CODE 0712
ADLAWAN
PAYING ORGANIZATION CODE 71247001 DATE PREPARED 04/18/2024
ADDRESS BRGY. ADLAWAN , VALENCIA BILL NO. (YR-MONTH-NUMBER)
B-0712-202404-2116
COMPUTATION OF FIDELITY BOND PREMIUM DUE
AMOUNT BOND
FUND CODE TRANSACTION CODE AMOUNT
(at 1.5% per annum / P 150.00)
03104344 4020219000 10,000.00 150.00

TOTAL AMOUNT PAYABLE 150.00

PREPARED BY: APPROVED BY:

LUZANO, JAMES RENE CHLOE P. REDEJA

Treasury Operations Officer III Officer In Charge
Signature Over Signature Over
Printed Name and Position Printed Name and Position

FOR BANK USE ONLY

DETAILS OF PAYMENT
PARTICULARS DRAWEE BANK / NUMBER
CASH P
CHECK
TOTAL PAYMENT RECEIVED P
BANK MACHINE VALIDATION OF AMOUNT AND DATE