DISBURSEMENT VOUCHER

SK of Barangay: Binocaran DV No.: 2022-08-

003
City/Municipality: Malimono Date :
Province: Surigao del Norte
Address: Binocaran, Malimono, Surigao del Norte
TIN:
Particulars Amount

Cash advance for the expenses on Variety Show performer’s fee (to cover
transportation, music equipment, instruments, snacks and meals) per
₱10,000.00
supporting papers hereto attach in the amount of…

A. Certified as to availability B. Certified as to availability C. Certified as to necessity,

of the budget or funds received of cash, and completeness and validity, propriety, and legality
for specific purpose propriety of supporting of claim; and Approved for
documents payment:

LUCILYN G. GUMEMBA MARNIEL C. ESPINOZA DJ STACY MARIE T.

(Signature Over Printed Name) (Signature Over Printed Name) LADRES
Budget Monitoring Officer SK Treasurer SK Chairperson (Signature Over Printed
Name)
SK Chairperson
Date : _____________ Date : _____________ Date : _____________
D. Received Payment:
Check
No.:
KENNETH G. CORVERA Date:
Signature over Printed Name of Payee/ Bank
Authorized Representative Name:
 Bank
___________________ Branch
Date OR No.:
Date:
DISBURSEMENT VOUCHER
(DV)

INSTRUCTIONS
A. This form shall be used by the SK Treasurer to pay individuals/entities/creditors for goods
purchased by or services rendered to the SK. It shall be accomplished as follows:
1. SK of Barangay – name of the barangay SK
2. City/Municipality – the city/municipality of the barangay
3. Province – the province of the barangay
4. Payee – name of individual/entity to whom the payment is to be made
5. Address – address of the claimant/payee
6. TIN – Tax Identification Number of the claimant/payee
7. DV No. – shall be numbered as follows:

0000 – 00 – 000
Serial number (one series for each year)
Month
Year

8. Date – date of preparation of the DV

9. Particulars – brief description of the expenses to be paid
10. Amount – amount to be paid
11. Box A – Certification of the Budget Monitoring Officer as to availability of the budget
based on the Registry of Budget, Commitments, Payments and Balances or availability of
funds received for specific purpose based on the Registry of Specific Purpose Fund,
Commitments, Payments and Balances
12. Box B – Certification of the SK Treasurer as to availability of cash based on Register of
Cash in Bank and Other Related Financial Transactions and as to completeness and
propriety of supporting documents
13. Box C – Certification of the SK Chairperson as to the necessity, validity, propriety and
legality of the claim and approval of the SK Chairperson on the payment covered by the
DV
14. Box D – acknowledgement by the claimant/payee or his/her duly authorized
representative of the receipt of the check. The claimant/payee or his/her duly authorized
representative shall sign and indicate the date of receipt of the check, the number and date
of the check, and bank’s name and branch, and number and date of the official
receipt/other relevant documents issued to acknowledge receipt of payment.

B. The DV shall be prepared in four copies to be distributed as follows:

Original copy - COA Auditor

2nd copy - SK Treasurer
3rd copy - Budget Monitoring Officer
4th copy - Claimant/Payee