Annex 12



A. This form shall be accomplished as follows:

1. DV No. - number assigned to the disbursement voucher. It shall be numbered as follows:

2. Date - the date the DV is prepared
3. Barangay - name of the barangay
4. Payee - name of payee
5. City/Municipality - the city/municipality of the barangay
6. Province - province of the barangay
7. TIN - Tax Identification Number (TIN) of the claimant
8. Fund - fund against which the claim shall be charged (GF, STF, SKF)
9. Particulars - brief description of the expenses/expenditures for payment.
10. Amount - amount of the claim.
11. Box A - Certification of the Chairman of the Committee on Appropriations (CCA) as to availability of appropriations for obligations.
12. Box B - Certification of the BT as to availability of funds for the purpose and as to completeness and propriety of supporting documents.
13. Box C - Certification of the PB as to the validity, propriety and legality of the claim and approval of the PB on the payment covered by the DV.
14. Box D Accounting Entries - the C/M Accountant shall prepare the necessary accounting entries for the particular transaction. Columns for account title, account code and the debited and credited amounts shall be filled up by the accountant.
15. Box E - acknowledgement by the claimant or his duly authorized representative on the receipt of the check and the date of receipt. The claimant/payee shall indicate the number and date of check, bank's name and branch, and number and date of OR/other relevant documents issued to acknowledge receipt of payment.

B. DV shall be prepared in three copies to be distributed as follows:

Original - COA auditor concerned thru the C/M Accountant
2nd copy - BT file
3rd copy - Payee

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