Appendix 42

LIST OF DUE AND DEMANDABLE ACCOUNTS PAYABLE - ADVICE TO DEBIT

ACCOUNTS (LDDAP-ADA)

Department : ___________________________ LDDAP-ADA No. ________________

Entity Name : ___________________________ Date : __________________________
Operating Unit : _________________________ Fund Cluster : ___________________
MDS-GSB BRANCH/MDS SUB ACCOUNT NO.: _____________________________

I. LIST OF DUE AND DEMANDABLE ACCOUNTS PAYABLE (LDDAP)

CREDITOR In Pesos
Obligation ALLOTMEN
PREFERRED SERVICING Request and T CLASS per REMARKS
GROSS WITHHOLDIN NET
NAME BANKS/SAVINGS/CURRENT Status No. (UACS) AMOUNT G TAX AMOUNT
ACCOUNT NO.

FOR MDS-
I. Current Year A/Ps GSB USE
ONLY

Sub-total

II. Prior Year's A/Ps

Sub-total
TOTAL P______ P _____ P ______ -

I hereby warrant that the above List of Due and I hereby assume full responsibility for the veracity
Demandable A/Ps was prepared in accordance with existing and accuracy of the listed claims, and the authencity of
budgeting, accounting and auditing rules and regulations. the supporting documents as submitted by the claimants.

Certified Correct: Approved:

(Signature over Printed Name)

Head of Accounting Division/Unit (Signature over Printed Name)
Head of Agency or Authorized
Official
II. ADVICE TO DEBIT ACCOUNT (ADA)
To: MDS-GSB of the Agency
Please debit MDS Sub-Account Number : ________________________________
Please credit the accounts of the above listed creditors to cover payment of accounts payable

TOTAL AMOUNT : P
(In Words)

Agency Authorized Signatories

1. 2.

(Erasures shall invalidate this document)

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