Annex B

Republic of the Philippines

DEPARTMENT OF EDUCATION
DepED Complex, Meralco Avenue, Pasig City
No.
DISBURSEMENT VOUCHER

Mode of MDS Check Commercial Check ADA Others

Payment
TIN/Employee No. OR/BUR No.
Payee

Responsibility Center
Office/Unit/Project Code
Address

EXPLANATION AMOUNT

A. Certified B. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Supporting documents complete

Signature Signature

Printed Printed
Name Name

Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative

Date Date

C. Received Payment JEV No.

Check/ Date Bank Name

ADA No.
Date Printed Name Date
Signature

Official Receipt/Other Documents