IMPORTANT: PLEASE FOLLOW CAREFULLY INSTRUCTIONS AND CHECKLIST ON THE BACK HEREOF, PER COA CIRCULAR NO.

92

GENERAL FORM NO. 1

REVISED NOVEMBER 3, 1992

Prepared by:

Republic of the Philippines JANE RAIZA REJANO-CANDIDO

DISBURSEMENT VOUCHER
PAYING AGENCY
SOCIAL SECURITY SYSTEM

NAME AND ADDRESS OF CLAIMANT EMPLOYEE NO/TIN

EASTERN SAMAR ELECTRIC COOPERATIVE, INC.
Borongan E. Samar 000-571-316-000

PARTICULARS OF PAYMENT AMOUNT

Payment for the electric consumption of SO Borongan for the period from
February 28 to March 27, 2020

422 kwhr 3,203.01

DUE DATE: 05/04/2020

38.59/.12= 321.58

Attachment:
Statement of Billing No.o.RB0520200300039
RB0620200100261

A
CERTIFIED Expenses/cash advance
necessary, lawful and incurred
under my direct supervision. AILEEN A. OLARAN
BRANCH HEAD
PRINTED NAME, DESIGNATION AND SIGNATURE OF OFFICER
B
OBLIGATION FPA OBJECT CODE ACCOUNT CODE DEBIT CREDIT
60205001-21310031 3,203.01
20202028 5% Final Vat* 16.08
10101002 3,186.93

JOURNALIZED INDEXED C. Approved: For 3,203.01

BY/DATE BY/DATE Three thousand two hundred

CERTIFIED: Adequate available funds/budgetary allotment in the amount of 3,203.01 three pesos and 01/100
expenditure properly certified;supported by documents marked (x) per checklist on the
back hereof, account codes proper;previous cash advance liquidated/accounted for.
VP MARIO V. CORRO
Visayas Central II Division
GENEVIEVE S. TONIDO PRINTED NAME AND SIGNATURE
OIC Head, Admin and General Accounting Section OF APPROVING OFFICER/REPRESENTATIVE
PRINTED NAME AND SIGNATURE OF ACCOUNTANT

CHECK FOR COA USE ONLY

NO RECEIVED FROM __________________ ALLOWED IN AUDIT: For (P_____________)
Amt Releasing Officer
Date ________________________________
OFFICIAL RECEIPT Amount in Words Amount in Words
NO ________________________________
Date
EASTERN SAMAR ELECTRIC COOPERATIVE, INC.
PRINTED NAME AND SIGNATURE OF CLAIMANT PRINTED NAME AND SIGNATURE OF AUDITOR