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Accountable Form No.

89-C
Revised January, 1992 (ORIGINAL)
Official Receipt
Of the
Republic of the Philippines
No. 9564678 M
Date:
Tuesday, Septemer 03, 2019
Agency CVSU IMUS CAMPUS Fund
Payor Alarcon, Keano A.
Nature of Account Code Amount
Collection
Certificate of ₱375.00
Diploma

Total ₱375.00
Amount in Words
THREE HUNDRED NINETY NINE
Drawee Bank Number

Cash
Check
Money Order

Received the amount stated above.

Collecting Officer
NOTE: Write the number and date of this receipt on
the back of check or money order received

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