Revised COA Circular No.

2006-003 1/31/06

Republic of the Philippines

ABC DEPARTMENT
CSU Rd., Tuguegarao City, 3500, Cagayan
No.

DISBURSEMENT VOUCHER

Mode of

Others

MDS Check

Commercial Check

ADA

Payment

Annex E

Payee

TIN/Employee No.
OR/BUR No.

Responsibility Center

Address

Office/Unit/Project
Code

EXPLANATION

AMOUNT

Less: 1%

5%
Value Added Tax

Net Amount

Cash Control No.

_________________________________
Payee/Creditor Bank Acct. No.

NCA No./Date

_________________________________
LDDAP Batch No./Date

Bank Acct No.

_________________________________

A. Certified

B. Approved for Payment 137,232.14

Cash available

TRA

One hundred thirty-seven thousand two

Subject to Authority to Debit Account (when applicable)

hundred thirty-two pesos and 14/100.

Supporting documents complete

Amount

Signature

Signature

Printed

Printed

Name

Name

Position

Accountant IV
Position

Regional Director

Head, Accounting Unit/Authorized Representative

Agency Head/Authorized Representative

Date

Date

C. Received Payment

JEV No.

Check/

Date

Bank Name

ADA NO.

Signature

Date
Printed Name

Date

Official Receipt/Other Documents

ACCOUNTING ENTRIES

RESP.

ACCOUNTS AND EXPLANATION

ACCOUNT

REF

AMOUNT

CENTER

CODE

DEBIT

CREDIT

Thank you for evaluating

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