RepublicofthePhilippines

COMMISSIONONAUDIT
CommonwealthAvenue,QuezonCity

Serial No. : _____________________

OBLIGATION REQUEST AND STATUS Date : _________________________

Fund Cluster : ___________________

Payee REBECCA P. MANUEL, ET AL.

Office Cluster 2 - Legislative and Oversight, NGS, Central Office
Address Commonwealth Avenue, Quezon City
UACS Object
Responsibility Center Particulars MFO/PAP Amount
Code

Payment of Cellular Phone Card Allowance

for the 1st Quarter (January to March) 4,200.00
calendar year 2016

Total 4,200.00
A. Certified: Charges to appropriation/alloment are B. Certified: Allotment available and obligated
necessary, lawful and under my direct supervision;and for the purpose/adjustment necessary as
supporting documents valid, proper and legal indicated above

Signature : ___________________________________ Signature : ______________________________

Printed Name: ADELINA CONCEPCION L. ANCAJAS Printed Name: ______________________________

Director IV
Position : Cluster 2-Legislative and Oversight Position : ______________________________

Head, Requesting Office/Authorized Representative Head, Budget Division/Unit/Authorized

Representative
Date : ___________________________________ Date : ____________________________

C. STATUS OF OBLIGATION
Reference Amount
Balance
ORS/JEV/Check/ Obligation Payable Payment Due and
Date Particulars Not Yet Due
ADA/TRA No. Demandable
(a) (b) (c) (a-b) (b-c)
 Republic of the Philippines Fund Cluster :
COMMISSION ON AUDIT
Commonwealth Avenue, Quezon City
Date :
DISBURSEMENT VOUCHER DV No. :

Mode of MDS Check Commercial Check xx ADA Others (Please specify)

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee REBECCA P. MANUEL, ET AL.
Cluster 2 - Legislative and Oversight, NGS, Central Office
Address
Commonwealth Avenue, Quezon City
Responsibility
Particulars MFO/PAP Amount
Center
Payment of Cellular Phone Card Allowance for the 1st 4,200.00
Quarter (January to March) calendar year 2016

Amount Due 4,200.00

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

ADELINA CONCEPCION L. ANCAJAS

Director IV
Cluster 2-Legislative and Oversight

B. Accounting Entry:
Account Title UACS Code Debit Credit

C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Sup
proper

Signature Signature

Printed
Printed Name
Name

Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative

Date Date
E. Receipt of Payment JEV No.
Check/ Date : Bank Name & Account Number:
ADA No. :
Date : Printed Name: Date
Signature :
 Signature : Date : Printed Name:

Official Receipt No. & Date/Other Documents

 Fund Cluster :

Date :

DV No. :

ORS/BURS No.:

NGS, Central Office

Amount

4,200.00

4,200.00
wful and incurred under my direct supervision.

2-Legislative and Oversight

Credit

Agency Head/Authorized Representative

 Republic of the Philippines Fund Cluster :
COMMISSION ON AUDIT
Commonwealth Avenue, Quezon City
Date :
DISBURSEMENT VOUCHER DV No. :

Mode of MDS Check Commercial Check xx ADA Others (Please specify)

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee FE RACHEL Q. BERMUDEZ
Cluster 2 - Legislative and Oversight, NGS, Central Office
Address
Commonwealth Avenue, Quezon City
Responsibility
Particulars MFO/PAP Amount
Center

Payment of Yuletide Allowance

25,000.00

0.00
Amount Due 25,000.00
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

ADELINA CONCEPCION L. ANCAJAS

Director IV
Cluster 2-Legislative and Oversight
B. Accounting Entry:
Account Title UACS Code Debit Credit

C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Sup
proper

Signature Signature

Printed
Printed Name
Name

Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative

Date Date
E. Receipt of Payment JEV No.
Check/ Date : Bank Name & Account Number:
ADA No. :
Date : Printed Name: Date
Signature :
Official Receipt No. & Date/Other Documents