Appendix 34

CHECKS AND ADVICES TO DEBIT ACCOUNT DISBURSEMENTS RECORD

Entity Name : _________________________________________ Fund Cluster :___________________

Bank Name/Bank Account Number : _____________________ Sheet No. : _____________________

________________________________________________ ___________________________ _______________________

Accountable Officer Official Designation Station
NCA/DS/DV/Payroll Check/ADA Amount

UACS Object Nature

Payee
Code of Payment NCA Received/ ADA NCA/Bank
No. Date Serial No. Date Date Released
Deposit Made
Check Issued
Issued Balance

20-11-001 11/2/2020 MOOE Downloading - Nov 27,000.00 27,000.00

046701 11/6/2020 11/6/2020 Panelco III 5020402000 electric bill - october 2020 5,000.00 22,000.00

CERTIFICATION

I hereby certify on my official oath that the foregoing is a correct and complete record of all checks/ADAs issued by me in my capacity as _________________________ of
_____________________________________
(Designation) (Name of Agency)
during the period from _______________ to _______________, inclusive, as indicated in the corresponding columns.

___________________________
Name and Signature
________________
Date

96
 Appendix 34

CHECKS AND ADVICES TO DEBIT ACCOUNT DISBURSEMENTS RECORD

Entity Name : CABANBANAN NATIONAL HIGH SCHOOL Fund Cluster :_________7_________

Bank Name/Bank Account Number : LBP-URDANETA/000112-1173-00 Sheet No. : _____1/1________________

FRANCISCO B. TORRES JR. PRINCIPAL III CABANBANAN NHS

Accountable Officer Official Designation Station
NCA/DS/DV/Payroll Check/ADA Amount

UACS Object Nature

Payee
Code of Payment NCA Received/ ADA NCA/Bank
No. Date Serial No. Date Date Released
Deposit Made
Check Issued
Issued Balance

CABANBANAN NHS 1010202000 CM 170,000.00 170,000.00

ADVANCES FOR OPERATING EXPENSES

2020-12-00001 12/23/2020 1592701 12/23/2020 12/23/2020 FRANCISCO B. TORRE 1990101000 Sept.-Oct. 2020 170,000.00 -

CERTIFICATION

I hereby certify on my official oath that the foregoing is a correct and complete record of all checks/ADAs issued by me in my capacity as SCHOOL HEAD-PRINCIPAL III of CABANBANAN NATIONAL HIGH SCHOOL
(Designation) (Name of Agency)
during the period from DEC 1 to DEC 31,2020, inclusive, as indicated in the corresponding columns.

FRANCISCO B. TORRES JR.

Name and Signature
2/26/2021
Date

96
 Appendix 34

CHECKS AND ADVICES TO DEBIT ACCOUNT DISBURSEMENTS RECORD

Entity Name : CABANBANAN NATIONAL HIGH SCHOOL Fund Cluster :_________7_________

Bank Name/Bank Account Number : LBP-URDANETA/000112-1173-00 Sheet No. : _____1/1________________

FRANCISCO B. TORRES JR. PRINCIPAL III CABANBANAN NHS

Accountable Officer Official Designation Station
NCA/DS/DV/Payroll Check/ADA Amount

UACS Object Nature

Payee
Code of Payment NCA Received/ ADA NCA/Bank
No. Date Serial No. Date Date Released
Deposit Made
Check Issued
Issued Balance

CABANBANAN NHS 1010202000 CM (Additional MOOE Fund for Covid) 6,650.00 6,650.00

2021-2-00001 2/24/2021 1592702 2/24/2021 2/24/2021 EVANGELINE GLASSWARE STORE 5020399000 Purchase of PPE Supplies-SHS 6,650.00 -

CERTIFICATION

I hereby certify on my official oath that the foregoing is a correct and complete record of all checks/ADAs issued by me in my capacity as SCHOOL HEAD-PRINCIPAL III of CABANBANAN NATIONAL HIGH SCHOOL
(Designation) (Name of Agency)
during the period from FEBRUARY 1-28,2021, inclusive, as indicated in the corresponding columns.

FRANCISCO B. TORRES JR.

Name and Signature
3/1/2021
Date

96
 Appendix 34

CHECKS AND ADVICES TO DEBIT ACCOUNT DISBURSEMENTS RECORD

Entity Name : CABANBANAN NATIONAL HIGH SCHOOL Fund Cluster :_________7_________

Bank Name/Bank Account Number : LBP-URDANETA/000112-1173-00 Sheet No. : _____1/1________________

FRANCISCO B. TORRES JR. PRINCIPAL III CABANBANAN NHS

Accountable Officer Official Designation Station
NCA/DS/DV/Payroll Check/ADA Amount

UACS Object Nature

Payee
Code of Payment NCA Received/ ADA NCA/Bank
No. Date Serial No. Date Date Released
Deposit Made
Check Issued
Issued Balance

CABANBANAN NHS 1010202000 CM (Additional MOOE Fund for Covid) 19,000.00 19,000.00

2021-3-00002 3/1/2021 1592703 3/1/2021 3/1/2021 EVANGELINE GLASSWARE STORE 5020399000 Purchase of PPE Supplies-JHS 8,400.00 10,600.00
VALENCERINA'S PHARMACY AND
2021-3-00003 3/4/2021 1592704 3/4/2021 3/4/2021 GEN. MERCHANDISE 5020399000 Purchase of PPE Supplies-JHS 6,000.00 4,600.00
2021-3-00004 3/8/2021 1592706 3/8/2021 3/8/2021 EVANGELINE GLASSWARE STORE 5020399000 Purchase of PPE Supplies-JHS 4,600.00 -

CERTIFICATION

I hereby certify on my official oath that the foregoing is a correct and complete record of all checks/ADAs issued by me in my capacity as SCHOOL HEAD-PRINCIPAL III of CABANBANAN NATIONAL HIGH SCHOOL
(Designation) (Name of Agency)
during the period from MARCH 1-15,2021, inclusive, as indicated in the corresponding columns.

FRANCISCO B. TORRES JR.

Name and Signature
3/15/2021
Date

96