Republic of the Philippines

Department of Education
Division of Apayao

DISBURSEMENT VOUCHER

Mode of Payment Number:

Date:
□MDS Check □Commercial check □ADA □Others

□Cash Advance □Reimbursement □ Other Payments

Name of Claimant TIN/Emp. No. OS No. _____

____________
Kalliat Ementary School Date:
Kalliat, Lenneng, Kabugao, Apayao Resp. Center COA
Title: Code
Particulars Amount

A) Certified _____ Supporting Documents B) Approved for payment

_____ Cash Available
_____ Subject to ADA (where
applicable)

EDDIEROSE F. GARCIA REBECCA F. SUET

Special Disbursing Officer School Head

C ) Received Payment: Check No: _____________ D ) Journal Entry Voucher

Date: _____________
No: _______________
Date: __________________________ Bank Name: ___________
Date: ______________
OR No. / Other relevant
document issued.
 Republic of the Philippines
DEPARTMENT OF EDUCATION
Division of Apayao
Kabugao District
Kalliat Elementary School

Date: _________
Canvass No: _________________
Sir/ Madam:
Please quote your lowest price/s, taxes included on each of the following item/s listed below. Submit said canvass
to the Chairman of the Bids and Committee. The Canvass will open at _____________________, 20 ______.

Item Articles Quantity Unit of U-Price Total Price

No. Issue

The item/s quoted above is/are to be delivered to this office within calendar days during the office hours after
receipt of duly approved purchased order.

JULIUS P. SADAG
School Head

Respectfully returned to the Chairman, PBAC with prices quoted. All conditions set by that office are hereby
accepted. A bond deposit of _______________ is enclosed.

Date submitted: ____ ____________________

Name and Signature of Supplier