Annex 12



Disbursement Voucher DV No. :
Barangay: City/Municipality: Date :
Payee: Province: Fund:
Address: TIN : ObR No.
Particulars Amount







A. Certified:

As to availability of appropriation

As to obligation of appropriation

_______________________
(Signature Over Printed Name)

Chairman, Committee on Appropriation
Date:_____________
B. Certified:


As to availability of funds

As to completeness and propriety of supporting documents

_______________________
(Signature Over Printed Name)

Barangay Treasurer

Date:_____________
C. Certified:


As to validity, propriety, and legality of claim

Approved for Payment:

_______________________
(Signature Over Printed Name)

Punong Barangay

Date:_____________
D. Accounting Entries
Account Account Code Debit Credit









E. Received Payment:

___________________________
Signature Over Printed Name

Check No.: _____________
Bank Name:____________
OR No.: _______________
Date: _______


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