Revised
CASH EXAMINATION
Manual
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Annex A

Republic of the Philippines
Department of finance
BUREAU OF THE TREASURY- A5514
Office of the District/ChiefTrensury Operations OrncerII

National Capital rcgion - District I
Address

To: -------- Land Bank of the Philippines ---------------------------------------------ATAP NO. _______________
-------------ln tramuros Branch

AUTHORITY TO ACCEPT PAYMENT
FOR DEPOSIT TO SAVINGS ACCOUNT OF THE TREASURER OF THE PHILIPPINES
PAYING AGENCY AREA CODE
PAYING AGENCY CODE DATE PREPARED
ADDRESS BILL NO.(YEAR-MONTH-NUMBER)

COMPUTATION OF FIDELITY BOND PREMIUM DUE
FUND CODE TRANSACTION CODE AMOUNT OF BOND (at 1.5% perrannum/PlSO.OO) AMOUNT

P








TOTAL AMOUNT PAYABLE P
PREPARED BY:

__________________________________
Signature over Printed Name
and position
APPROVE BY:

____________________________________
Signature over Printed Name
and position
FOR BANK'S USE ONLY
DETAILS OF PAYMENT
PARTICULARS DRAWEE BANK/NUMBER
CASH
P
CHECK

TOTAL PAYMETN RECIEVED
P
BANK MACHINE VALIDATION OF AMOUNT AND DATE



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