Republic of the Philippines

PROVINCIAL GOVERNMENT OF NEGROS ORIENTAL

Dumaguete City, Negros Oriental Annex B
No.
DISBURSEMENT VOUCHER
Mode of
payment Check Cash Others
Tin/Employee No. Obligation Request No.
Payee NORECO 1
Responsibility Center: 4421-4 R
Address Bindoy, Negros Oriental Office/Unit/Project Code
Bindoy Dist. Hosp. 50204020
EXPLANATION AMOUNT

To payment of Electric Bill for the month of September 2018

of Bindoy District Hospital, attached herewith are supporting
papers all in the amount of . . . . . . . . . . . P 83,388.49

Main Bldg. - 77,613.47

X-ray Dept. - 5,775.02
83,388.49

A Certified: B. Certified
Allotment obligated for the purpose as indicated above Funds Available
Supporting document complete

Signature Signature
Printed Date Printed Date
Name DAHLIA G. TAN-CUAL Name JOJI F. RENACIA
Position OIC-Provincial Accountant Position ICO-Provincial Treasurer
Head Accounting Unit/Authorized Rep. Treasurer/Authorized Representative
C. Approved for Payment D. Received Payment
Signature Check No. Bank Name Date
Printed Signature
Name HON. ROEL R. DEGAMO Printed Name Noreco 1
Position Provincial Governor OR/Other Documents JEV No. Date
Agency Head/Authorized Representative
 PROVINCIAL GOVERNMENT OF NEGROS ORIENTAL
Dumaguete City, Negros Oriental Annex B
No.
DISBURSEMENT VOUCHER
Mode of
payment Check Cash Others
Tin/Employee No. Obligation Request No.
Payee AYUNGON WATER DISTRICT
Responsibility Center: 4421-4 I
Address Ayungon, Negros Oriental Office/Unit/Project Code
Bindoy Dist. Hosp. 50204010
EXPLANATION AMOUNT

To payment of Water bill for the month of July,

August & Sept. 2018 of Bindoy District Hospital, attached
herewith are supporting papers all in the amount of . . . . . . . . . . . P 90,774.00

July - 33,862.00
Aug.- 28,721.00
Sept.- 28,191.00
90,774.00

A Certified: B. Certified
Allotment obligated for the purpose as indicated above Funds Available
Supporting document complete
Signature Signature
Printed Date Printed Date
Name DAHLIA G. TAN-CUAL Name JOJI F. RENACIA
Position OIC- Provincial Accountant Position ICO-Provincial Treasurer
Head Accounting Unit/Authorized Rep. Treasurer/Authorized Representative
C. Approved for Payment D. Received Payment
Signature Check No. Bank Name Date
Printed Signature
Name HON. ROEL R. DEGAMO Printed Name AWD
Position Provincial Governor OR/Other Documents JEV No. Date
Agency Head/Authorized Representative
 PROVINCIAL GOVERNMENT OF NEGROS ORIENTAL
Dumaguete City, Negros Oriental Annex B
No.
DISBURSEMENT VOUCHER
Mode of
payment Check Cash Others
Tin/Employee No. Obligation Request No.
Payee TopTechnologies and IT Solutions
Responsibility Center: 4421-4 R
Address Dumaguete City Office/Unit/Project Code
Bindoy Dist. Hosp. 50205030
EXPLANATION AMOUNT

To payment of Internet Exp. for the month of April & May 2018
of Bindoy District Hospital, attached herewith are supporting
papers all in the amount of . . . . . . . . . . . P 6,000.00

A Certified: B. Certified
Allotment obligated for the purpose as indicated above Funds Available
Supporting document complete
Signature Signature
Printed Date Printed
Name DAHLIA G. TAN-CUAL Name JOJI F. RENACIA
Position OIC- Provincial Accountant Position ICO-Provincial Treasurer
Head Accounting Unit/Authorized Rep. Treasurer/Authorized Representative
C. Approved for Payment D. Received Payment
Signature Check No. Bank Name
Printed Signature
Name HON. ROEL R. DEGAMO Printed Name TopTech
Position Provincial Governor OR/Other Documents JEV No.
Agency Head/Authorized Representative
L
Annex B

Date

orized Representative

Date

Date
 Republic of the Philippines
PROVINCIAL GOVERNMENT OF NEGROS ORIENTAL
Dumaguete City, Negros Oriental Annex B
No.
DISBURSEMENT VOUCHER
Mode of
payment Check Cash Others
Tin/Employee No. Obligation Request No.
Payee Rosalie Vailoces
Responsibility Center:
Address Tagaytay,Bindoy Neg. Or. Office/Unit/Project Code
Bindoy Dist. Hosp.
EXPLANATION AMOUNT

To refund Philhealth Claims for drugs/medicine of

Mikaela Vailoces, addmitted at BIN DOY DISTRICT
HOSPITAL,Bindoy Neg.Or.,in the amount of. . . . . . 1,205.00

A Certified: B. Certified
Allotment obligated for the purpose as indicated above Funds Available
Supporting document complete
Signature Signature
Printed Date Printed Date
Name DAHLIA G. TAN-CUAL Name JOJI F. RENACIA
Position OIC-Provincial Accountant Position ICO-Provincial Treasurer
Head Accounting Unit/Authorized Rep. Treasurer/Authorized Representative
C. Approved for Payment D. Received Payment
Signature Check No. Bank Name Date
Printed Signature
Name HON. ROEL R. DEGAMO Printed Name Rosalie Vailoces
Position Provincial Governor OR/Other Documents JEV No. Date
Agency Head/Authorized Representative