DISBURSEMENT VOUCHER

SK of Barangay: DV No.:
City/Municipality: Date :
Province:
Payee:

Address:

TIN:

Particulars Amount

A. Certified as to availability B. Certified as to availability of cash, and

C. Certified as to necessity, validity, propriety, and
of the budget or funds completeness and propriety of supporting
legality of claim; and Approved for payment:
received for specific purpose documents

________________________
(Signature Over Printed Name) (Signature Over Printed Name) (Signature Over Printed Name)
Budget Monitoring Officer SK Treasurer SK Chairperson

D. Received Payment Check No.:

Date:
Bank Name :
________________________________
Signature Over Printed Name of Payee/
Bank Branch :
Authorized Representative
___________________ OR No.:
Date Date: