Unit of

No Quantity Item Description

issue
1 20 ltrs Brake Fluid
2 20 cans Air Freshener
3 20 ltrs ATF
4 15 ltrs Gear Oil #90
5 15 ltrs Gear Oil #40
6 5 pcs Kanebo
7 5 cans Oil Filter
8 5 pcs Fuel Filter
9 5 btls Tire Black
10 75 ltrs Motor Oil
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 Republic of the Philippines
Provincial Government of Ilocos Norte
PACT-003-0
Provincial Capitol Building, Laoag City 2900
(077) 772-1211 to (077) 7721219
dran 2006
No.
Disbursement Voucher
Mode of
Payment Check Cash Others
TIN/Employee No. Obligation Request No.
Payee

Responsibility Center
Address Office/Unit/Project Code

Explanation Amount

A. Certified B. Certified
P Allotment obligated for the purpose as indicated above Funds Available
P Supporting documents complete
Date: Date:
Signature Signature
Printed Printed
Name Name

Position Position
C. Approved for Payment D. Received Payment
Date: Check No. Bank Name Date:
Signature
Printed Signature
Name Printed Name Date:
OR/Other Documents JEV No. Date:
Position

FOR ACCOUNTING USE ONLY

JOURNAL ENTRY VOUCHER No.
Provincial Government of Ilocos Norte
Date:
LGU
Collection Check Disbursement Cash Disbursement Others
Responsibility Accounting Entries
Center Account Amount
Accounts and Explanation PR Debit Credit
Code
 TOTAL
Prepared by: Indexed by: OK as to fund: No Outstanding CA Approved by: