Annex 17



A. This form shall be prepared to summarize the payments made out of petty cash. It shall be attached to the DV for the replenishment and to the LR for the liquidation of the petty cash together with supporting documents. This form shall be accomplished as follows:

1. For the period - period covering the report/Summary
2. Barangay - name of the barangay
3. Barangay Treasurer - name of the Barangay Treasurer
4. City/Municipality - the city or municipality of the barangay
5. Province - province of the barangay
6. Date - date indicated in the OR/Ref.
7. Ref. - indicate the PCV No. or any other reference evidencing payments
8. Payee - name of the payee
9. Particulars - brief description of the nature of payments
10. Amount - amount paid
11. Certification - to be signed by the BT

B. It shall be prepared in two copies to be distributed as follows:

Original - to the local auditor concerned, through the C/M Accountant (attached to DV for replenishment)
2nd copy - to the BT

Back | Annex 18

| Table of Contents | Home |