Professional Documents
Culture Documents
To - Excel
To - Excel
15
Credit
6911
600.56
19,500
8,999
2,219.50
1,301
806
650
1,650
657.75
995.25
450
364.36
500
D
Payee
Address
Particulars
Amount Due
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.
B. Accounting Entry:
Account Title
C. Certified:
Cash available
Signature
Printed Name
Position
Head, Accounting Unit/Authorize
Date
E. Receipt of Payment
Signature :
DISBURSEMENT VOUCHER
TIN/Employee No.:
Responsibility Center
ue
on.
________________________________________
Printed Name, Designation and Signature of Supervisor
Signature
Printed Name
Position
Head, Accounting Unit/Authorized Representative
Date
Date :
DV No. :
Signature
Printed Name
Position
Agency Head/Authorized Representative
Date
JEV No.
e & Account Number:
me: Date
Amount
Credit
ve
OBLIGATION REQUEST AND STATUS
HSL AGENCY
Entity Name
Office
Address
Total
A. B.
Certified: Charges to appropriation/alloment are Certified: Allotment availab
necessary, lawful and under my direct supervision;and for the purpose/adjustment n
supporting documents valid, proper and legal indicated above
Printed Name:
_________________
Signature :
_________________ ___________________________________ Signature :
__ ___________________________________ Printed Name:
Position : ___________________________________ Position :
Head, Requesting Office/Authorized Representative
Date : ___________________________________ Date :
C. STATUS OF OBLIGATION
Reference Amount
(a) (b)
MOOE - Electricity ₱ 5,004.00
Serial No. : 02-01101101-2021-03-000019 OBLIGATION REQUEST AN
Date : March 24, 2021 HSL AGENCY
Fund Cluster : Regular Agency Fund Entity Name
Payee PLDT
Office
Address
UACS
Object Amount Responsibility Center Particulars
Code
5-02-04-02 ₱ 5,004.00 MOOE - Internet Subs
₱ 5,004.00
A.
rtified: Allotment available and obligated Certified: Charges to appropriation/alloment
r the purpose/adjustment necessary as necessary, lawful and under my direct supervision;and
dicated above supporting documents valid, proper and legal
Printed Name:
_________________
______________________________ Signature :
_________________ ___________________________________
______________________________ __ ___________________________________
______________________________
Head, Budget Division/Unit/Authorized Position : ___________________________________
Representative Head, Requesting Office/Authorized Repres
____________________________ Date : ___________________________________
N C. ST
Amount Reference
Balance
Payment ORS/JEV/Check/
Not Yet Due Due and Demandable Date Particulars
ADA/TRA No
Office
Address
UACS
Particulars MFO/PAP Object Amount Responsibility Ce
Code
MOOE - Internet Subscription 103-00-1-00-00-000005-02-05-03 ₱ 1,907.00
Total ₱ 1,907.00
B. A.
o appropriation/alloment are Certified: Allotment available and obligated
direct supervision;and for the purpose/adjustment necessary as
oper and legal indicated above
Printed Name:
_________________
___________________ Signature : ______________________________ Signature :
_________________
___________________ Printed Name: ______________________________ __
Head, Budget
___________________ Position : ______________________________
Division/Unit/Authorized Position :
Office/Authorized Representative Representative
___________________ Date : ____________________________ Date :
STATUS OF OBLIGATION C.
e Amount
Balance
Office
Address
Total
B.
Certified: Charges to appropriation/alloment are Certified: Allotment available and obli
necessary, lawful and under my direct supervision;and for the purpose/adjustment necessary as
supporting documents valid, proper and legal indicated above
Printed Name:
_________________
Signature :
_________________ ___________________________________ Signature :
__ ___________________________________ Printed Name:
Position : ___________________________________ Position :
Head, Requesting Office/Authorized Representative
Date : ___________________________________ Date :
STATUS OF OBLIGATION
Reference Amount
(a) (b)
MOOE - Water Expenses ₱ 600.56
Serial No. : 02-01101101-2021-01-000019
Date :April 12, 2021 HSL AGENC
Fund Cluster : Regular Agency Fund Entity Name
Office
Address
UACS Object
Amount Responsibility Center Particula
Code
5-02-04-01000 ₱ 600.56 MOOE - Furniture a
₱ 600.56
A.
Certified: Allotment available and obligated Certified: Charges to appropriation/allom
for the purpose/adjustment necessary as necessary, lawful and under my direct supervision;an
indicated above supporting documents valid, proper and legal
Printed Name:
_________________
______________________________ Signature :
_________________ __________________________________
______________________________ __ __________________________________
______________________________
Head, Budget Division/Unit/Authorized Position : __________________________________
Representative Head, Requesting Office/Authorized Rep
____________________________ Date : __________________________________
ION C.
Amount Reference
Balance
Payment Due and
Not Yet Due Date Particulars
Demandable
Superama Hypermarket
UACS Object
Particulars MFO/PAP Amount
Code
MOOE - Furniture and Fixtures 103-00-1-00-00-00000 5-02-04-020 ₱ 19,500.00
Total ₱ 19,500.00
B.
Charges to appropriation/alloment are Certified: Allotment available and obligated
d under my direct supervision;and for the purpose/adjustment necessary as
ts valid, proper and legal indicated above
STATUS OF OBLIGATION
Reference Amount
Balance
Obligation Payable Payment Due and
ORS/JEV/Check/
Not Yet DueDemanda
ADA/TRA No.
ble
(a) (b) (c) (a-b) (b-c)
₱ 19,500.00
HSL AGENCY
Entity Name
Office
Address
Total
A. B.
Certified: Charges to appropriation/alloment are
necessary, lawful and under my direct supervision;and
supporting documents valid, proper and legal
Printed Name:
_________________
Signature :
_________________ ___________________________________ Signature :
__ ___________________________________ Printed Name:
Position : ___________________________________ Position :
Head, Requesting Office/Authorized Representative
Date : ___________________________________ Date :
C. STATUS OF OBLIGATION
Reference Amount
(a) (b)
MOOE - Mobile ₱ 8,999.00
Date :April 12, 2021 HSL AGENCY
Fund Cluster : Regular Entity Name
Agency Fund
Payee Mercury Drug - Cot City Rosary Heig
Office
Address
UACS
MFO/PAP Object Amount Responsibility Center Particulars
Code
103-00-1-00-00-000005-02-05-01 ₱ 8,999.00 MOOE - Drugs and Medicine Ex
₱ 8,999.00
A.
Certified: Allotment available and obligated Certified: Charges to appropriation/alloment are
for the purpose/adjustment necessary as necessary, lawful and under my direct supervision;and
indicated above supporting documents valid, proper and legal
Printed Name:
_________________
Signature : ______________________________ Signature :
_________________ ___________________________________
Printed Name: ______________________________ __ ___________________________________
Head, Budget
Position : ______________________________
Division/Unit/Authorized Position : ___________________________________
Representative Head, Requesting Office/Authorized Representati
Date : ____________________________ Date : ___________________________________
TION C. STATUS O
Amount Reference
Balance
Payable Payment Due and
ORS/JEV/Check/
Not Yet DueDemanda Date Particulars
ADA/TRA No.
ble
(b) (c) (a-b) (b-c)
MOOE - Drugs and Medicine Expenses
HSL AGENCY Date :June 11, 2021
Entity Name Fund Cluster : Regular
Agency Fund
Drug - Cot City Rosary Heights Sinsuat Ave. Payee
Office
Address
UACS
Particulars MFO/PAP Object Amount Responsibility Center
Code
OOE - Drugs and Medicine Expenses 103-00-1-00-00-000005-02-03-07 ₱ 2,219.00
Total ₱ 2,219.00
B. A.
o appropriation/alloment are Certified: Allotment available and obligated
direct supervision;and for the purpose/adjustment necessary as
oper and legal indicated above
Printed Name:
_________________
___________________ Signature : ______________________________ Signature :
_________________
___________________ Printed Name: ______________________________ __
Head, Budget
___________________ Position : ______________________________
Division/Unit/Authorized Position :
Office/Authorized Representative Representative
___________________ Date : ____________________________ Date :
STATUS OF OBLIGATION C.
e Amount
Balance
Obligation Payable Payment Due and
ORS/JEV/Check/
Not Yet DueDemanda Date
ADA/TRA No.
ble
(a) (b) (c) (a-b) (b-c)
₱ 2,219.00
HSL AGENCY Date :April 12, 2021
Entity Name Fund Cluster : Regular
Agency Fund
Payee CITIHARDWARE GENSAN INC.,
Office
Address
UACS
Responsibility Center Particulars MFO/PAP Object
Code
MOOE - Other Land Improvements 103-00-1-00-00-000005-02-13-02
Total
B.
Certified: Charges to appropriation/alloment are Certified: Allotment available and obli
necessary, lawful and under my direct supervision;and for the purpose/adjustment necessary as
supporting documents valid, proper and legal indicated above
Printed Name:
_________________
Signature :
_________________ ___________________________________ Signature : ________________________
__ ___________________________________ Printed Name: ________________________
Head, Budget
Position : ___________________________________ Position : ________________________
Division/Unit/Authorized
Head, Requesting Office/Authorized Representative Representative
Date : ___________________________________ Date : ________________________
STATUS OF OBLIGATION
Reference Amount
Office
Address
₱ 1,301.00 Total
A.
: Allotment available and obligated Certified: Charges to appropriation/alloment are
urpose/adjustment necessary as necessary, lawful and under my direct supervision;and
supporting documents valid, proper and legal
Printed Name:
_________________
______________________________ Signature :
_________________ ___________________________________
______________________________ __ ___________________________________
Head, Budget
______________________________
Division/Unit/Authorized Position : ___________________________________
Representative Head, Requesting Office/Authorized Representative
____________________________ Date : ___________________________________
C. STATUS OF OBLIGATION
ount Reference
Balance
Due and
ORS/JEV/Check/
Not Yet DueDemanda Date Particulars
ADA/TRA No.
ble
(a-b) (b-c)
MOOE - Drugs and Medicine Expenses
Date :June 11, 2021 HSL
Fund Cluster : Regular En
Agency Fund
y Plaza Payee
Office
Address
UACS
rs MFO/PAP Object Amount Responsibility Center
Code
dicine Expenses 103-00-1-00-00-000005-02-03-07 ₱ 806.00
Total ₱ 806.00
B. A.
ent are Certified: Allotment available and obligated Certified:
d for the purpose/adjustment necessary as necessary, lawful and under my direct su
indicated above supporting documents valid, proper and
Printed Name:
_________________
_ Signature : ______________________________ Signature :
_________________ ________________________
_ Printed Name: ______________________________ __ ________________________
Head, Budget
_ Position : ______________________________
Division/Unit/Authorized Position : ________________________
Representative Head, Requesting Office/Au
_ Date : ____________________________ Date : ________________________
ATUS OF OBLIGATION C.
Amount Reference
Balance
Obligation Payable Payment Due and
Not Yet DueDemanda Date Particulars
ble
(a) (b) (c) (a-b) (b-c)
₱ 806.00 MOOE - Other Professional Services
HSL AGENCY Date :June 11, 2021
Entity Name Fund Cluster : Regular
Agency Fund
ANIMAL CLINIC
UACS
Particulars MFO/PAP Object Amount
Code
MOOE - Other Professional Services 103-00-1-00-00-000005-02-11-99 ₱ 650.00
Total ₱ 650.00
B.
Charges to appropriation/alloment are Certified: Allotment available and obligated
, lawful and under my direct supervision;and for the purpose/adjustment necessary as
g documents valid, proper and legal indicated above
STATUS OF OBLIGATION
Reference Amount
Balance
Obligation Payable Payment Due and
ORS/JEV/Check/
Particulars Not Yet DueDemanda
ADA/TRA No.
ble
(a) (b) (c) (a-b) (b-c)
her Professional Services ₱ 650.00
HSL AGENCY
Entity Name
Office
Address
Total
A. B.
and obligated Certified: Charges to appropriation/alloment are
necessary, lawful and under my direct supervision;and
supporting documents valid, proper and legal
Printed Name:
_________________
______________ Signature :
_________________ ___________________________________ Signature :
______________ __ ___________________________________ Printed Name:
______________ Position : ___________________________________ Position :
Head, Requesting Office/Authorized Representative
____________ Date : ___________________________________ Date :
C. STATUS OF OBLIGATION
Reference Amount
(a) (b)
MOOE - Fuel, Oil and Lubricant Expenses ₱ 1,650.00
Date :June 11, 2021 HSL AGENCY
Fund Cluster : Regular Entity Name
Agency Fund
ION Payee Savemore
Office
Address
UACS
MFO/PAP Object Amount Responsibility Center Particulars
Code
103-00-1-00-00-000005-02-03-07 ₱ 1,650.00 MOOE - Food Supplies Expe
₱ 1,650.00
A.
Certified: Allotment available and obligated Certified: Charges to appropriation/alloment are
for the purpose/adjustment necessary as necessary, lawful and under my direct supervision;and
indicated above supporting documents valid, proper and legal
Printed Name:
_________________
Signature : ______________________________ Signature :
_________________ ___________________________________
Printed Name: ______________________________ __ ___________________________________
Head, Budget
Position : ______________________________
Division/Unit/Authorized Position : ___________________________________
Representative Head, Requesting Office/Authorized Representati
Date : ____________________________ Date : ___________________________________
TION C. STATUS O
Amount Reference
Balance
Payable Payment Due and
ORS/JEV/Check/
Not Yet DueDemanda Date Particulars
ADA/TRA No.
ble
(b) (c) (a-b) (b-c)
MOOE - Food Supplies Expense
HSL AGENCY Date :June 11, 2021
Entity Name Fund Cluster : Regular
Agency Fund
e Payee
Office
Address
UACS
Particulars MFO/PAP Object Amount Responsibility Center
Code
MOOE - Food Supplies Expense 103-00-1-00-00-000005-02-03-05 ₱ 657.75
Total ₱ 657.75
B. A.
o appropriation/alloment are Certified: Allotment available and obligated
direct supervision;and for the purpose/adjustment necessary as
oper and legal indicated above
Printed Name:
_________________
___________________ Signature : ______________________________ Signature :
_________________
___________________ Printed Name: ______________________________ __
Head, Budget
___________________ Position : ______________________________
Division/Unit/Authorized Position :
Office/Authorized Representative Representative
___________________ Date : ____________________________ Date :
STATUS OF OBLIGATION C.
e Amount
Balance
Obligation Payable Payment Due and
ORS/JEV/Check/
Not Yet DueDemanda Date
ADA/TRA No.
ble
(a) (b) (c) (a-b) (b-c)
₱ 657.75
HSL AGENCY Date :June 11, 2021
Entity Name Fund Cluster : Regular
Agency Fund
Payee Mercury Drug - Cotabato City Plaza
Office
Address
UACS
Responsibility Center Particulars MFO/PAP Object
Code
MOOE - Drugs and Medicine Expenses 103-00-1-00-00-000005-02-03-07
Total
B.
Certified: Charges to appropriation/alloment are Certified: Allotment available and obli
necessary, lawful and under my direct supervision;and for the purpose/adjustment necessary as
supporting documents valid, proper and legal indicated above
Printed Name:
_________________
Signature :
_________________ ___________________________________ Signature : ________________________
__ ___________________________________ Printed Name: ________________________
Head, Budget
Position : ___________________________________ Position : ________________________
Division/Unit/Authorized
Head, Requesting Office/Authorized Representative Representative
Date : ___________________________________ Date : ________________________
STATUS OF OBLIGATION
Reference Amount
Office
Address
₱ 995.25 Total
A.
: Allotment available and obligated Certified: Charges to appropriation/alloment are
urpose/adjustment necessary as necessary, lawful and under my direct supervision;and
supporting documents valid, proper and legal
Printed Name:
_________________
______________________________ Signature :
_________________ ___________________________________
______________________________ __ ___________________________________
Head, Budget
______________________________
Division/Unit/Authorized Position : ___________________________________
Representative Head, Requesting Office/Authorized Representative
____________________________ Date : ___________________________________
C. STATUS OF OBLIGATION
ount Reference
Balance
Due and
ORS/JEV/Check/
Not Yet DueDemanda Date Particulars
ADA/TRA No.
ble
(a-b) (b-c)
MOOE - Other Professional Services
Date :June 11, 2021 HSL
Fund Cluster : Regular En
Agency Fund
Payee
Office
Address
UACS
rs MFO/PAP Object Amount Responsibility Center
Code
ional Services 103-00-1-00-00-000005-02-11-99 ₱ 450.00
Total ₱ 450.00
B. A.
ent are Certified: Allotment available and obligated Certified:
d for the purpose/adjustment necessary as necessary, lawful and under my direct su
indicated above supporting documents valid, proper and
Printed Name:
_________________
_ Signature : ______________________________ Signature :
_________________ ________________________
_ Printed Name: ______________________________ __ ________________________
Head, Budget
_ Position : ______________________________
Division/Unit/Authorized Position : ________________________
Representative Head, Requesting Office/Au
_ Date : ____________________________ Date : ________________________
ATUS OF OBLIGATION C.
Amount Reference
Balance
Obligation Payable Payment Due and
Not Yet DueDemanda Date Particulars
ble
(a) (b) (c) (a-b) (b-c)
₱ 450.00 MOOE - Office Supplies Expense
HSL AGENCY Date :June 11, 2021
Entity Name Fund Cluster : Regular
Agency Fund
FIESTA SHOPPING CENTER
UACS
Particulars MFO/PAP Object Amount
Code
MOOE - Office Supplies Expense 103-00-1-00-00-000005-02-03-01 ₱ 364.36
Total ₱ 364.36
B.
Charges to appropriation/alloment are Certified: Allotment available and obligated
, lawful and under my direct supervision;and for the purpose/adjustment necessary as
g documents valid, proper and legal indicated above
STATUS OF OBLIGATION
Reference Amount
Balance
Obligation Payable Payment Due and
ORS/JEV/Check/
Particulars Not Yet DueDemanda
ADA/TRA No.
ble
(a) (b) (c) (a-b) (b-c)
Office Supplies Expense ₱ 364.36
HSL AGENCY
Entity Name
Office
Address
Total
A. B.
and obligated Certified: Charges to appropriation/alloment are
necessary, lawful and under my direct supervision;and
supporting documents valid, proper and legal
Printed Name:
_________________
______________ Signature :
_________________ ___________________________________ Signature :
______________ __ ___________________________________ Printed Name:
______________ Position : ___________________________________ Position :
Head, Requesting Office/Authorized Representative
____________ Date : ___________________________________ Date :
C. STATUS OF OBLIGATION
Reference Amount
(a) (b)
MOOE - Fuel, Oil and Lubricant Expenses ₱ 500.00
Date :June 11, 2021
Fund Cluster : Regular
Agency Fund
UACS
MFO/PAP Object Amount
Code
103-00-1-00-00-000005-02-03-07 ₱ 500.00
₱ 500.00
Signature : ______________________________
Printed Name: ______________________________
Head, Budget
Position : ______________________________
Division/Unit/Authorized
Representative
Date : ____________________________
TION
Amount
Balance
Payable Payment Due and
Not Yet DueDemanda
ble
(b) (c) (a-b) (b-c)