REPUBLIC OF THE PHILIPPINES Fund Cluster :

DEPARTMENT OF EDUCATION
SCHOOLS DIVISION OFFICE OF PAMPANGA
High School Blvd., Brgy. Lourdes, City of San Fernando (Pampanga)
Date :
DISBURSEMENT VOUCHER DV No. :

Mode of MDS Check Commercial Check ADA Others (Please specify)

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee MANAO, PERCELITO B, et al

Address STA. ANA, PAMPANGA

Responsibility
Particulars MFO/PAP Amount
Center

To record payment of : 16,538.00

Year End Bonus & Cash Gift
Period Covered : CY 2019

SCHOOL ID: 123456

SCHOOL: XXXXX JHS/SHS
DISTRICT: STA. ANA

Amount Due 16,538.00

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

Printed Name, Designation and Signature of School Head

B. Accounting Entry:
Account Title UACS Code Debit Credit

Year End Bonus 50102140 11,538.00

Cash Gif 50102150 5,000.00
Cash - MDS, Regular 10104040 16,538.00
C. Certified: D. Approved for Payment
ü Cash available
ü Subject to Authority to Debit Account (when applicable)
ü Supp
proper

Signature Signature

Printed
Printed Name
Name Erwin M. Cruz ZENIA G. MOSTOLES, Ed.D., CESO V

Accountant III Schools Division Superintendent

Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative

Date Date

E. Receipt of Payment JEV No.

 Check/ Date : Bank Name & Account Number:
ADA No. : LANDBANK
Signature : Date : Printed Name: Date

Official Receipt No. & Date/Other Documents

 Fund Cluster :

Date :
DV No. :

ORS/BURS No.:

Amount

16,538.00

16,538.00
ul and incurred under my direct supervision.

Credit

16,538.00

ZENIA G. MOSTOLES, Ed.D., CESO V

Schools Division Superintendent

Agency Head/Authorized Representative

 Republic of the Philippines
Department of Education
SCHOOLS DIVISION OFFICE OF PAMPANGA
High School Blvd., Brgy. Lourdes, City of San Fernando (Pampanga)
OBLIGATION REQUEST AND STATUS

Payee/Office: MANAO, PERCELITO B, et al No:

Date:
Address: STA. ANA, PAMPANGA Fund:

Responsibility
Particulars MFO/PAP UACS Code/ Expenditure Amount
Center

To obligate payment of : 16,538.00

Year End Bonus & Cash Gift
Period Covered : CY 2019

SCHOOL: XXXXX JHS/SHS

DISTRICT: STA. ANA TOTAL
SCHOOL ID: 123456 16,538.00
A. Certified: Charges to appropriation/allotment necessary, B. Certified: Allotment available and obligated for the
lawful and under my direct supervision, and supporting purpose/adjustment necessary as indicated above.
documents valid, proper and legal.

SCHOOL HEAD REMEDIOS M. BACANI

Position Admin. Officer V

C. STATUS OF OBLIGATION
Reference Amount
Date Particulars ORS/JEV/RCI/RADAI No. Obligation Payment Not Yet Due Due and Demandable

YEAR END BONUS 16,538.00 16,538.00

Totals
 DEPARTMENT OF EDUCATION
Region III
Schools Division Office of Pampanga

YEAR END BONUS CY 2019

NAME OF DISTRICT

NAME OF SCHOOL:

EMPLOYEE YEAR END TOTAL

NO. NAME POSITION STATUS CASH GIFT NO. ACCOUNT NO.
ID # BONUS AMOUNT DUE
1 4132973 MANAO, PERCELITO B UTILITY WORKER I P 11,538.00 5,000.00 16,538.00 1 0085103130
2 0 0 0.00 2 0
3 0 0 0.00 3 0
4 0 0 0.00 4 0
5 0 0 0.00 5 0
6 0 0 0.00 6 0
7 0 0 0.00 7 0
8 0 0 0.00 8 0
9 0 0 0.00 9 0
10 0 0 0.00 10 0
11 0 0 0.00 11 0
12 0 0 0.00 12 0
13 0 0 0.00 13 0
14 0 0 0.00 14 0
15 0 0 0.00 15 0
16 0 0 0.00 16 0
17 0 0 0.00 17 0
18 0 0 0.00 18 0
19 0 0 0.00 19 0
20 0 0 0.00 20 0
21 0 0 0.00 21 0
22 0 0 0.00 22 0

Page 6 of 9
 DEPARTMENT OF EDUCATION
Region III
Schools Division Office of Pampanga

YEAR END BONUS CY 2019

NAME OF DISTRICT

NAME OF SCHOOL:

EMPLOYEE YEAR END TOTAL

NO. NAME POSITION STATUS CASH GIFT NO. ACCOUNT NO.
ID # BONUS AMOUNT DUE
23 0 0 0.00 23 0
24 0 0 0.00 24 0
25 0 0 0.00 25 0

GRAND TOTAL 11,538.00 5,000.00 16,538.00

1) I HEREBY CERTIFY on my official oath that the payroll is (2) Approved 3) I HEREBY CERTIFY on my official oath that I have paid thru ATM the school
correct and the services above stated have been duly rendered, officials whose names appear on this payroll amount opposite their names.
payment approved from the appropriation indicated.

NAME OF SCHOOL HEAD ZENIA G. MOSTOLES, Ed.D, CESO V JANET B. MARCELO

Position Schools Division Superintendent Administrative Officer IV

Page 7 of 9
 DEPARTMENT OF EDUCATION
Region III
Schools Division Office of Pampanga

FORM 7

NAME OF DISTRICT

SCHOOL NAME:
EMPLOYEE BASIC
NO. NAME POSITION STATUS
ID # SALARY
1
4132973 MANAO, PERCELITO B UTILITY WORKER I P 11,538.00
2
3
4
5
6
7
8
9
10

CERTIFIED TRUE & CORRECT:

NAME OF SCHOOL HEAD

POSITION
 T OF EDUCATION
egion III
n Office of Pampanga

ORM 7

F DISTRICT

PERFORMANCE
PERIOD COVERED REMARKS
RATING
MATERNITY 01/01/2019 -
(1/1/2019-10/31/2019) VS
LEAVE 02/28/2019
01/01/19;
ON LEAVE
01/30/19; 03/31/19
NEWLY HIRED 08/31/2019
RETIRED 02/01/2019
NONE NONE

APPROVED BY:

DEXTER E. PANGILINAN
Administrative Officer IV
HRMO