Revised COA Circular No.

2006-003 1/31/06

Annex E

Republic of the Philippines

ABC DEPARTMENT
(Address)

No.

DISBURSEMENT VOUCHER
Mode of
Payment

MDS Check

Commercial Check

ADA

TIN/Employee No.

Payee

Others
OR/BUR No.

Responsibility Center
Office/Unit/Project
Code

Address

EXPLANATION

AMOUNT

Less: 1%
5%Value Added Tax
Net Amount

Cash Control No.

NCA No./Date
Bank Acct No.

_________________________________
_________________________________
_________________________________

A. Certified
Cash available

Payee/Creditor Bank Acct. No.

LDDAP Batch No./Date

B. Approved for Payment

TRA

Subject to Authority to Debit Account (when applicable)

Supporting documents complete

Amount

Signature

Signature

Printed
Name

Printed
Name

Position

Accountant IV
Head, Accounting Unit/Authorized Representative

Date

Position

Regional Director
Agency Head/Authorized Representative

Date

C. Received Payment

JEV No.

Check/
ADA NO.

Date

Bank Name

Signature

Date

Printed Name

Date

Official Receipt/Other Documents

RESP.
CENTER

ACCOUNTING ENTRIES
ACCOUNT
ACCOUNTS AND EXPLANATION
CODE

REF

AMOUNT
DEBIT

CREDIT

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