Mode of

Payment
Payee

Republic of the Philippines

Municipality of Kalibo
Kalibo, Aklan
No.
DISBURSEMENT VOUCHER
Check

Cash

Others

TIN/Employee No.

PANTELCO

Obligation Request No.

Responsibility Center:

Address

Kalibo, Aklan

Office/Unit/Project

1131

Code

EXPLANATION

AMOUNT

To payment to Telephone bill used at Municipal Legal Office, Kalibo, Aklan for the
month of September 1-30, 2011 as per supporting papers hereto attached in the total
amount of ____________________________

378.00

Less: W/holding Tax

5%
2%

A.

16.88
6.75

23.63

NET AMOUNT DUE . . . . . . . . . . . . . . . . . . . . . . . . .

Certified
Certified
B.
Allotment obligated for the purpose as indicated above

354.37

Funds Available

Supporting Documents Complete

Signature
Printed Name
Position

C.

Signature

FREDIE C. MALACAS

Date:

Municipal Accountant
Head, Accounting Unit/Authorized Representative

Approved for Payment

Treasurer/Authorized Representative

Received Payment

Check No.:
Date:

Bank Name:

Date:

Signature:

WILLIAM S. LACHICA
Printed Name:

Position

Date:

Municipal Treasurer

Position

D.

Signature

Printed Name

ELSA M. TABUENA

Printed Name

Municipal Mayor
Agency Head/Authorized Representative

O R/Other Documents:

PANTELCO
JEV No.

Date:
Date:

Republic of the Philippines

Municipality of Kalibo
Kalibo, Aklan

OBLIGATION REQUEST
PANTELCO

Payee
Office
Address

Kalibo, Aklan

Responsibility
Center

1131

No.:

Particulars

F.P.P.

Account
Code

Kalibo Municipal Legal Office

September 1-30, 2011

200

772

Total
A.

Certified

B.

Amount

378.00

378.00

Certified

Charges to appropriation/allotment necessary, lawful

Existence of available appropriation

and under my direct supervision

Supporting documents valid, proper and legal
Signature
Printed
Name
Position
Date

Signature

WILLIAM S. LACHICA
Municipal Mayor
Head, Requesting Office/Authorized Representative

Printed Name
Position
Date

NANNIE A. ROLDAN
Mun. Budget Officer
Head, Budget Unit/Authorized Representative