Appendix 11

OBLIGATION REQUEST AND STATUS Serial No. : _2019-07-010_ _

__KATIDTUAN CENTRAL ELEMENTARY SCHOOL__ Date : ___7/ /2019 ______

Entity Name Fund Cluster : GENERAL FUND____

Payee DARYL R. DE VERA

Office

Address KABACAN, COTABATO

UACS Object
Responsibility Center Particulars MFO/PAP Amount
Code

Incurred Payment for the LABOR 5-02-10-010 2,500.00

AND WAGES EXPENSES

Total 2,500.00
A. Certified: Charges to appropriation/alloment are B. Certified: Allotment available and obligated
necessary, lawful and under my direct supervision;and for the purpose/adjustment necessary as
supporting documents valid, proper and legal indicated above

Signature : ___________________________________ Signature : ______________________________

Printed Name: ______EVELYN E. BAREZ_______ Printed Name: _____JAYZEL C. BALUCOS_____

Position : _ _Principal I_____________ Position : _____ Book Keeper______________

Head, Requesting Office/Authorized Representative Head, Budget Division/Unit/Authorized

Representative
Date : ________ _7/ /2019______________ Date : _____ 7/ /2019 ____________

C. STATUS OF OBLIGATION
Reference Amount
Balance
ORS/JEV/Check/ Obligation Payable Payment Due and
Date Particulars Not Yet Due
ADA/TRA No. Demandable
(a) (b) (c) (a-b) (b-c)

Incurred Payment for

the LABOR AND 2,500.00
WAGES EXPENSES
2,500.00

42
 Proposed
REPORT OF CHECKS ISSUED
01/28
Period Covered: ________________
2014-01-028
Agency : JDG Department Report No.: ___________
Fund : 01 1234
Bank Name/Account No. _________________ 1
Sheet No.: _______________
Check DV No. / ORS/BUR Responsibility UACS Code/
Payee MFO/PAP/KRA Amount
Date No. Payroll No. Center Code Expenditure
1/28 023 2014-02-010 010 26-036-00-00000 ABC Corporation 3 01 01 0000 50604050 03 44,000 00
123

44,000 00

CERTIFICATION
I hereby certify that this Report of Checks Issued (RCI) in _________ sheet(s) is a full,
true and correct statement of all checks issued by me in payment for obligations for the period stated and
shown in the attached disbursement vouchers.
AO 6/15/02

Juan dela Cruz 01/29/14

Disbursing Date
Officer