Republic of the Philippines

Department of Education
Region V
SCHOOLS DIVISION OFFICE OF ALBAY
Ligñon Hill, Bogtong, Legazpi City
Telefax: (052) 481-5939. Website: www.depedalbay.com.ph

Serial No.:
Date:
Fund Cluster :
OBLIGATION REQUEST AND STATUS 101101
101407
104102
Others

Payee MELANIE T. PREAGOLA

Office PANTAO ELEMENTARY SCHOOL
Address PANTAO, LIBON, ALBAY
Responsibility
Particulars MFO/PAP UACS Object Code Amount
Center

103001000100000
To payment for Salary as Regular Permanent Teacher I 269002000800000
from the period June 8, 2021- October __, 2021 270003020100000
amounting to ……………. 261003020500001 Php
261003020500002
262003020500003

Total Php -
A. Certified: Charges to appropriation/alloment are B. Certified: Allotment available and obligated
necessary, lawful and under my direct supervision;and for the purpose/adjustment necessary as
supporting documents valid, proper and legal indicated above

Signature : ___________________________________ Signature : ______________________________

Printed Name: Printed Name:

LAURO S. MILLANO ALBERT B. BONAGUA
Position : ASDS Position : Administrative Officer V (Budget)
Head, Requesting Office/Authorized
Representative
Budget Officer III D
___________________________________ Date : ____________________________ u
Date :
e

C. STATUS OF OBLIGATION a
Reference n
Balance (d
b
ORS/JEV/Check/ Obligation Payable Payment -D
Date Particulars Not Yet Due
ADA/TRA No. ec
(a) (b) (c) (a-b) m
)
a
n
d
a
b
l
e
 Republic of the Philippines Fund Cluster :
Department of Education
Region V 101101
SCHOOLS DIVISION OF ALBAY 101407
Ligñon Hill, Bogtong, Legazpi City 104102
Telefax : (052) 481-5939. Website: www.depedalbay.com.ph Others
Date :
DISBURSEMENT VOUCHER DV No. :

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

Payment
_________________
MELANIE T. PREAGOLA TIN/Employee No.: ORS/BURS No.:
Payee

Address PANTAO ELEMENTARY SCHOOL, LIBON WEST DISTRICT

Responsibility
Particulars MFO/PAP Amount
Center

To Payment for the Salary as Regular Permanent Teacher 1 P

at Pantao Elementary School for the period from June 8, 2021
onwards amounting to ……………….

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

LAURO S. MILLANO
Assistant Schools Division Superintendent

B. Accounting Entry:
Account Title UACS Code Debit Credit

P - P
-
P - P -
C. Certified: D. Approved for Payment
Cash available P
Subject to Authority to Debit Account (when applicable)
Sup
proper

Signature Signature

Printed
Printed Name
Name RAFAEL B. TRAJANO NORMA B. SAMANTELA, CESO VI
Accountant III
Position Position Schools Division Superintendent

Date Date
E. Receipt of Payment JEV No.
Check/ Date : Bank Name & Account Number:
ADA No. :
Date : Printed Name: Date
Signature :
Official Receipt No. & Date/Other Documents