QUIRINO STATE UNIVERSITY Fund Cluster :

Date :
DISBURSEMENT VOUCHER DV No. :

Mode of MDS Check Commercial Check ADA Others (Please specify)

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee MA. ROSA DOMINGO

Address

Responsibility
Particulars MFO/PAP Amount
Center
To partial payment of labor for the Repair/Rehabilitattion of BEED
Building (Concrete Works,Masonry works&Painting Works) in the
amount of……… 23,800.00

Amount Due 23,800.00

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

Engr. ELIZABETH G. SOMERA

Director of Physical Plant and Site Development

B. Accounting Entry:
Account Title UACS Code Debit Credit

C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Sup
proper

Signature Signature

Printed
Printed Name
Name LEILA M. SABBALUCA SAMUEL O. BENIGNO, Ph.D.
Accountant III President
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative

Date Date

E. Receipt of Payment JEV No.

Check/ Date : Bank Name & Account Number:
ADA No. :
Date : Printed Name: Date
Signature :
Official Receipt No. & Date/Other Documents
 QUIRINO STATE UNIVERSITY Fund Cluster :

Date :
DISBURSEMENT VOUCHER DV No. :

Mode of MDS Check Commercial Check ADA Others (Please specify)

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee MA. ROSA DOMINGO

Address

Responsibility
Particulars MFO/PAP Amount
Center
To partial payment of labor for the Repair/Rehabilitattion of BEED
Building (Concrete Works,Masonry works&Painting Works) in the
amount of……… 22,100.00

Amount Due 22,100.00

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

Engr. ELIZABETH G. SOMERA

Director of Physical Plant and Site Development

B. Accounting Entry:
Account Title UACS Code Debit Credit

C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Sup
proper

Signature Signature

Printed
Printed Name
Name LEILA M. SABBALUCA SAMUEL O. BENIGNO, Ph.D.
Accountant III President
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative

Date Date

E. Receipt of Payment JEV No.

Check/ Date : Bank Name & Account Number:
ADA No. :
Date : Printed Name: Date
Signature :
Official Receipt No. & Date/Other Documents
 QUIRINO STATE UNIVERSITY Fund Cluster :

Date :
DISBURSEMENT VOUCHER DV No. :

Mode of MDS Check Commercial Check ADA Others (Please specify)

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee MA. ROSA DOMINGO

Address

Responsibility
Particulars MFO/PAP Amount
Center
To partial payment of labor for the Repair/Rehabilitattion of BEED
Building (Concrete Works,Masonry works&Painting Works) in the
amount of……… 20,400.00

Amount Due 20,400.00

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

ELIZABETH G. SOMERA
Director of Physical Plant and Site Development

B. Accounting Entry:
Account Title UACS Code Debit Credit

C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Sup
proper

Signature Signature

Printed
Printed Name
Name LEILA M. SABBALUCA SAMUEL O. BENIGNO, Ph.D.
Accountant III President
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative

Date Date

E. Receipt of Payment JEV No.

Check/ Date : Bank Name & Account Number:
ADA No. :
Date : Printed Name: Date
Signature :
Official Receipt No. & Date/Other Documents
 QUIRINO STATE UNIVERSITY Fund Cluster :

Date :
DISBURSEMENT VOUCHER DV No. :

Mode of MDS Check Commercial Check ADA Others (Please specify)

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee MA. ROSA DOMINGO

Address

Responsibility
Particulars MFO/PAP Amount
Center
To partial payment of labor for the Repair/Rehabilitattion of BEED
Building (Concrete Works,Masonry works&Painting Works) in the
amount of……… 35,700.00

Amount Due 35,700.00

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

ELIZABETH G. SOMERA
Director of Physical Plant and Site Development

B. Accounting Entry:
Account Title UACS Code Debit Credit

C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Sup
proper

Signature Signature

Printed
Printed Name
Name LEILA M. SABBALUCA SAMUEL O. BENIGNO, Ph.D.
Accountant III President
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative

Date Date

E. Receipt of Payment JEV No.

Check/ Date : Bank Name & Account Number:
ADA No. :
Date : Printed Name: Date
Signature :
Official Receipt No. & Date/Other Documents
 QUIRINO STATE UNIVERSITY Fund Cluster :

Date :
DISBURSEMENT VOUCHER DV No. :

Mode of MDS Check Commercial Check ADA Others (Please specify)

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee Rogelic C. Dumalina
DIFFUN, QUIRINO
Address

Responsibility
Particulars MFO/PAP Amount
Center

To payment of cabinets fully furnished with accessories for

accreditation in the amount of……… 21,100.00

Amount Due P 21,100.00

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.
.

DENNIS S. OPIANO
OIC-Director of Physical Plant and Site Development

B. Accounting Entry:
Account Title UACS Code Debit Credit

C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Sup
proper

Signature Signature

Printed
Printed Name
Name LEILA M. SABBALUCA SAMUEL O. BENIGNO, Ph.D.
Accountant III President
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative

Date Date

E. Receipt of Payment JEV No.

Check/ Date : Bank Name & Account Number:
ADA No. :
Date : Printed Name: Date
Signature :
Official Receipt No. & Date/Other Documents
 QUIRINO STATE UNIVERSITY Fund Cluster :

Date :
DISBURSEMENT VOUCHER DV No. :

Mode of MDS Check Commercial Check ADA Others (Please specify)

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee PERSON HARDWARE
SANTIAGO CITY, ISABELA
Address

Responsibility
Particulars MFO/PAP Amount
Center

To payment of supply of Physical Plant and Site Development Office in

the amount of……… 10,775.00

(10,775.00/1.12)*1%= 107.75
(10,775.00/1.12)*5%= 538.75 646.50

Amount Due P 10,128.50

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.
.

DENNIS S. OPIANO
OIC-Director of Physical Plant and Site Development

B. Accounting Entry:
Account Title UACS Code Debit Credit

C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Sup
proper

Signature Signature

Printed
Printed Name
Name LEILA M. SABBALUCA SAMUEL O. BENIGNO, Ph.D.
Accountant III President
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative

Date Date

E. Receipt of Payment JEV No.

Check/ Date : Bank Name & Account Number:
ADA No. :
Date : Printed Name: Date
Signature :
Official Receipt No. & Date/Other Documents