Republic of the Philippines

DEPARTMENT OF SCIENCE AND TECHNOLOGY

Cordillera Administrative Region Km.6, La Trinidad, Benguet

DISBURSEMENT VOUCHER MDS Check MODE OF PAYMENT Commercial Check No. ADA Others Date. ObR No. TIN/Employee No.:

Payee/Office ROSEL B. BARBERO Address: DOST-CAR, Km. 6, La Trinidad, Benguet

Title Particulars

Date: Responsibility Center Code: Amount

To payment of cash advance for the Investors Fora and Technology Training for the Regional S&T Fair and Invention Contest cum Exhibition- Sept. 27-29, 2011 as per supporting documents hereto attached in the amount of ---------------

113, 600.

00

Amount Due

113,600.

00

[A] Certified

x x

Supporting documents and proper Cash available Subject to ADA (where applicable)

[B] Approved for Payment:

Signature:

_________________________

Signature:

__________________________

Printed Name: SHELA LORRAINE T. COSALAN Position Date: [C] Received Payment: Accountant III

Printed Name: BEN D. LADILAD Position: Date: [D] Journal Entry Voucher No.: Date: _________ _________ Regional Director

Check/ADA No.: __________ Signature: _______________ Date: _______ Date: __________ Bank Name: __________ Printed Name: ROSEL B. BARBERO Issued: __________