Annex 1

BTr FORM 1
(To be accomplished in quadruplicate)

1. Name of Agency/Bureau/Office

DOÑA GREGORIA RAMOS MEMORIAL SCHOOL (DEPED)

2. Type of Bank Account
MDS SAVINGS ACCOUNT
✔ CURRENT ACCOUNT OTHERS

3. Legal Basis and Purpose of Opening the Account

(State pertinent section/provision) COA-DBM-DepEd Joint Circular No.
2019-1 and DepEd Order No. 29, s.
R.A. ✔ Others 2019
E.O. (e.g. Special Provision in the GAA)
Please attach copy
4. Funding Source
✔ R.A. RA No. 11465 FY 2020 (GAA) Others
Grant

5. Authorized Signatory/Signatories

1. ALLENE GARTH A. FERNANDEZ 2.

6. Bank Branch where the Agency/Bureau/Office intend to open an Account

LANDBANK OF THE PHILIPPINES - KABANKALAN BRANCH

7. SIGNATURE OVER PRINTED NAME OF AUTHORIZED OFFICER

ALLENE GARTH A. FERNANDEZ

Do not fill-up this portion (For Bureau of the Treasury use only)

8.
APPLICATION REF. NO.:

EVALUATED BY:

APPROVED/DISAPPROVED BY:
(Signature over printed name of the Regional Director)

Reason for disapproval:

Do not fill-up this portion (For the bank use only)

9.

This is to confirm the existence in Account Name

(Name of Agency)

with Account Number in Branch .

Signature over printed name of the Authorized Bank Officer