Appendix 15

NBURSA No. : __________

NOTICE OF BUDGET UTILIZATION REQUEST AND
STATUS ADJUSTMENT Date : _________________
_______________________________ Fund Cluster : __________
Entity Name

For: The Budget Officer:

Budget Division/Unit

Please adjust BURS No. ___________________dated _______________

due to the following changes:

Responsibility Center to ___________________________

Particulars to ___________________________
MFO/PAP to ___________________________
Account Code to ___________________________
Amount to P ___________________________

Please adjust RBUD for excess/under obligation per attached

JEV No. ___________dated ____________.

A. B.
Prepared by: Approved by:

_________________________________ ___________________________________
Chief Accountant/Head of Accounting
Accounting Staff-in-Charge
Division/Unit

C. D.
Certified Correct: Verified by:

__________________________________ ________________________________
Head of the Requesting Office/Authorized Head of the Budget Division/Unit/Authorized
Representative Representative

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