Appendix 31

Sheet 1 of 2 Sheets

DAILY WAGE PAYROLL

HOSPITAL SERVICES
PROJECT
BPH - MARAMAG Period : January 1 - 15, 2016

Number Rate Gross Net Signature or Community Tax Certificate

Deductions
Name Designation of Days Per
Salary Pay Thumb Mark Number Date
Worked Day w/ Tax Pag ibig MTRY Late(Min) UNDERTIME
1 Ababa, Djona Thes G. Nurse I 843.13 - 0.00 1
2 Abrogueña, Mailyn T. Admin Aide III 472.77 - 0.00 2 7488.17
3 Abuhan, Nilme A. Dietitian/Nutritionist 843.13 - 0.00 3 5284.92
4 Acusar, Eden C. Pharmacist I 843.13 - 0.00 4
5 Akut, Miguel Karlo A. Admin Aide II 439.77 - 0.00 5
6 Albacia, Jackie Lou B. Nursing Attndnt I 508.22 - 0.00 6 6128.05
7 Ancheta, Mark Stephen C. Admin Aide II 439.77 - 0.00 7 5304.01
8 Antolihao, Mark Dave R. Nurse I 843.13 - 0.00 8 6112.24
9 Apita, Harold Jan Q. Nurse I 843.13 - 0.00 9 6128.05
10 Arayan, Raizha Z. Nurse I 843.13 - 0.00 10 7096.44
11 Balangyao, Ian Glenn B. Admin Aide I 409.09 - 0.00 11 5284.92
12 Balios, Jayceebelle M. NA I 508.22 - 0.00 12 6128.05
13 Bañez, Angel Mae C. Nurse I 843.13 - 0.00 13
14 Barrientos, Ellen L. Nurse I 843.13 - 0.00 14
15 Bartolaba, Meraflor T. Med Tech I 843.13 - 0.00 15 4453.67
16 Bioyo, Jonally D. Admin Aide III 472.77 - 0.00 16 6128.05
17 Branzuela, Marites H. Admin Aide I 409.09 - 0.00 17
18 Calahat, Octy Angelie D. Admin Aide II 439.77 - 0.00 18
19 Camello, Jessa Mae B. Nurse I 843.13 - 0.00 19 5209.39
20 Capada, Art John S. Rad Tech I 843.13 - 0.00 20
21 Chaves, Yvonne T. Nurse I 843.13 - 0.00 21
22 Cipriano, Jayfel Joy B. Nurse I 843.13 - 0.00 22 6089.41
23 Colegio, Paula Luz Igot Nurse I 843.13 - 0.00 23
24 Colipano, Airene D. Nurse I 843.13 - 0.00 24 8815.42
25 Crismundo, Dwight Denver D. Nurse I 843.13 - 0.00 25 6128.05
26 Curiba, Jayzel Shean U. Nurse I 843.13 - 0.00 26
27 Dacut, Julita C. Nurse I 843.13 - 0.00 27
28 Dawis, Ma. Daryl Jane T. Nurse I 843.13 - 0.00 28
29 Divinagracia, Rhea Nielyn C. Admin Aide II 439.77 - 0.00 29
30 Domasig, Carmille NA I 508.22 - 0.00 30
31 Doromal, Maria Theresa P. Nurse I 843.13 - 0.00 31
32 Dumapias, Roche T. Nurse I 843.13 - 0.00 32
33 Edejeran, Julievy L. Nurse I 843.13 - 0.00 33
34 Edrolin, Mark Art Brian S. NA I 508.22 - 0.00 34
35 Egang, Carla Mae R. Med Tech I 843.13 - 0.00 35
36 Eleazar, Klement Sylvester C. Med. Officer III 1,795.13 - 0.00 36
37 Enguio, Calvin Khlen V. Nurse I 843.13 - 0.00 37
38 Ensoy, Rex T. Nurse I 843.13 - 0.00 38
39 Flores, Renato II R. Admin Aide I 409.09 - 0.00 39
40 Halina, Marvin I. Admin Aide I 409.09 - 0.00 40
41 Jamis, Chezanne Jenn A. Nurse I 843.13 - 0.00 41
42 Lagrama, Crisette L. Admin Aide II 439.77 - 0.00 42
43 Lagumbay, Apple Rose B. Nurse I 843.13 - 0.00 43
44 Lamberang, Rochelle Y. Nurse I 843.13 - 0.00 44
45 Limbo, Nonito C NA I 508.22 - 0.00 45
46 Lindio, Victoriano A. Med Tech I 843.13 - 0.00 46
47 Lumpayao, Ma. Ruthchil N. Nurse I 843.13 - 0.00 47
48 Macalong, Daisy Grace Admin Aide I 409.09 - 0.00 48
49 Medrano, Toni Rose I. Nurse I 843.13 - 0.00 49
50 Mercado, Kristie Anne D. Nurse I 843.13 - 0.00 50
51 Miral, Maribeth A. Nurse I 843.13 - 0.00 51
52 Mirar, Gemarie Rose J. Nurse I 843.13 - 0.00 52
53 Molde, Charie Mae A. Nurse I 843.13 - 0.00 53
54 Moncatar, Ruby N. Nurse I 843.13 - 0.00 54
55 Monsanto, Elmer A. Admin Aide III 472.77 - 0.00 55
56 Murillo, Louie C. Nurse I 843.13 - 0.00 56
57 Nieles, Roen A. Admin Aide II 439.77 - 0.00 57
58 Nob, Roy N. Admin Aide I 409.09 - 0.00 58
59 Obedicen, Liezl Joy M. Nurse I 843.13 - 0.00 59
60 Obice, Kathleen E. Nurse I 843.13 - 0.00 60
61 Ochigue, Roselle S. NA I 508.22 - 0.00 61
62 Onipa, Crichelle S. Nurse I 843.13 - 0.00 62
63 Pacana, John Renant B. Admin Aide II 439.77 - 0.00 63
64 Palma, Harkin P. Rad. Tech I 843.13 - 0.00 64
65 Palma, Lowell Ace R. Jr. Nurse I 843.13 - 0.00 65
66 Payot, Elma A. NA I 508.22 - 0.00 66
67 Piamonte, Sheryl Joy L. Nurse I 843.13 - 0.00 67
68 Pugoy, Virgilio P. Admin Aide I 409.09 - 0.00 68
69 Salvani, Aillen O. NA I 508.22 - 0.00 69
70 Señoron, Viola D. Admin Aide II 439.77 - 0.00 70
71 Tan, Rheyna Belle P. Nurse I 843.13 - 0.00 71
72 Tecson, Xerxes Nicomedes T. Nurse I 843.13 - 0.00 72
73 Teves, Chloe Rose N. Nurse I 843.13 - 0.00 73
74 Tortor, Ivy Marie J. Nurse I 843.13 - 0.00 74
75 Valdepeña, Joselito Joel O. Admin Aide I 409.09 - 0.00 75
76 Veloso, Vicente D. Admin Aide I 409.09 - 0.00 76
77 Villanueva, Ma. Dolores Paula C Nurse I 843.13 - 0.00 77
78 Yap, Arcellie Marie A. Nurse I 843.13 - 0.00 78
79 Yee, Kirby T. Admin Aide I 409.09 - 0.00 79

TOTAL PAGE 1 0.00 0.00 0.00 0.00 0.00 0.00 91778.84

-
CERTIFIED: Approved for Payment: CERTIFIED:

Each person whose name appears on this roll had Each person whose name appears on the
rendered services for the time stated. above roll has been paid the amount stated opposite
his name after identifying him.

NELIA P. ORMILLADA VENUS V. TAGARDA, MD.

 Administrative Officer IV
_____________________________________ Chief of Hospital II
__________________________________ ___________________________________
Name and Signature of Approving Officer Name and Signature of Disbursing Officer
RJEB and OBRE 0.00
0.00

-7488.170
-5284.920

-6128.050
-5304.010
-6112.240
-6128.050
-7096.440
-5284.920
-6128.050

-4453.670
-6128.050

-5209.390

-6089.410

-8815.420
-6128.050
 Appendix 31
Sheet 2 of 2 Sheets

DAILY WAGE PAYROLL

HOSPITAL SERVICES
PROJECT
BPH - MARAMAG Period : December 16 - 31, 2015

Number Rate Gross Net Signature or Community Tax Certificate

Deductions
Name Designation of Days Per
Salary Pay Thumb Mark Number Date
Worked Day w/ Tax Pag ibig MTRY Late(Min) UNDERTIME
1 Lindio, Victoriano A. Med Tech I 11 843.13 9,274.43 - 9,274.43 1
2 Lumpayao, Ma. Ruthchil N. Nurse I 11 843.13 9,274.43 - 9,274.43 2
3 Medrano, Toni Rose I. Nurse I 11 843.13 9,274.43 - 9,274.43 3
4 Miral, Maribeth A. Nurse I 11 843.13 9,274.43 - 9,274.43 4
5 Molde, Charie Mae A. Nurse I 11 843.13 9,274.43 - 9,274.43 5
6 Moncatar, Ruby N. Nurse I 11 843.13 9,274.43 - 9,274.43 6
7 Murillo, Louie C. Nurse I 11 843.13 9,274.43 - 9,274.43 7
8 Nob, Roy N. Admin Aide I 11 409.09 4,499.99 - 4,499.99 8
9 Obedicen, Liezl Joy M. Nurse I 11 843.13 9,274.43 - 9,274.43 9
10 Ochigue, Roselle S. NA I 11 508.22 5,590.42 - 5,590.42 10
11 Onipa, Crichelle S. Nurse I 11 843.13 9,274.43 - 9,274.43 11
12 Payot, Elma A. NA I 11 508.22 5,590.42 - 5,590.42 12
13 Piamonte, Sheryl Joy L. Nurse I 11 843.13 9,274.43 - 9,274.43 13
14 Salvani, Aillen O. NA I 11 508.22 5,590.42 - 5,590.42 14
15 Tan, Rheyna Belle P. Nurse I 11 843.13 9,274.43 - 9,274.43 15
16 Tecson, Xerxes Nicomedes T. Nurse I 11 843.13 9,274.43 - 9,274.43 16
17 Tortor, Ivy Marie J. Nurse I 11 843.13 9,274.43 - 9,274.43 17
18 Veloso, Vicente D. Admin Aide I 11 409.09 4,499.99 - 4,499.99 18
19 Villanueva, Ma. Dolores Paula C Nurse I 11 843.13 9,274.43 - 9,274.43 19
TOTAL PAGE 2 155,613.26 0.00 0.00 0.00 0.00 155,613.26 0.00
TOTAL PAGE 1 0.00 0.00 0.00 0.00 - 0.00 0.00
GRAND TOTAL 155,613.26 0.00 0.00 0.00 0.00 155,613.26 0.00

155,613.26
CERTIFIED: Approved for Payment: CERTIFIED:

Each person whose name appears on this roll had Each person whose name appears on the
rendered services for the time stated. above roll has been paid the amount stated opposite
his name after identifying him.

NELIA P. ORMILLADA VENUS V. TAGARDA, MD.

Administrative Officer IV
_____________________________________ Chief of Hospital II
__________________________________ ___________________________________
Name and Signature of Approving Officer Name and Signature of Disbursing Officer
 155,613.26
RJEB and OBRE 155,613.26
155,613.26

155,613.26
0.00
155,613.26
 PROVINCE OF BUKIDNON

REQUEST FOR JOURNAL ENTRY VOUCHER (R-JEV) December 2, 2015

A. PARTICULARS/DETAILS / COMPUTATIONS AMOUNT REQUESTED BY

CLAIMANT: Ababa, Djona Thes G. & Co. 155,613.26

VENUS V. TAGARDA, MD.

NATURE OF PAYMENT : Salaries and Wages of Chief of Hospital II
BPH-Maramag Job Order personnel for January 1 - 15, 2016 Representative
B. ATTACHED DOCUMENTS (to be accomplished by ICD)
PRE-AUDITED BY
Description Code Document No. Date

C. PRO-FORMA JE (to be accomplished by the Accounting Division PRE-JEV

ACCOUNT TITLE Code DR CR

JEVER

JEV REVIEW

JEV APPROVED

D. CHECK NO. DATE ISSUED BANK ACCOUNT NO.

CHECKLIST OF ATTACHMENTS (to be accomplished by the concerned office)

SALARIES & WAGES

Obligation Request

Daily Time Record

Disbursement Voucher

NOTE : This form must be accomplished in 3 copies

GENERAL FORM No. 6
Revised January 1992

SUMMARY OF PAYROLLS
HOSPITAL SERVICES
Project
Agency BPH - MARAMAG: Period : January 1 - 15, 2016
AMOUNT UNPAID
PAYROLL NUMBER AMOUNT OF ROLLS AMOUNT PAID ON ROLLS
ON ROLLS
As of 2 sheets 155,613.26
ADD; Pag ibig -
Mortuary -
Withholding Tax -
155,613.26
-

TOTALS 155,613.26
Prepared by: GLEEN MARK G. DIMATULAC Certified Correct: NELIA P. ORMILLADA
Administrative Aide III Administrative Officer IV

ACCOUNTING ENTRY

ACCOUNT CODE DEBIT CREDIT CERTIFIED CORRECT

____________________________
Accountant
 Republic of the Philippines
Province of Bukidnon
Provincial Capitol 8700

OBLIGATION REQUEST No.:

Payee: Ababa, Djona Thes G. & Co.

Office: BPH Maramag

Address: Maramag, Bukidnon

Responsibility Account
PARTICULARS F.P.P. Amount
Center Code

Salary of Job Order Employees for the period

Maramag January 1 - 15, 2016 4422 155,613.26

Total - - - 155,613.26

A. Certified:
Charges to appropriation/allotment necessary, B. Certified:
lawful and under my direct supervision
Existence of available appropriation
Supporting documents valid, proper and legal

Signature: Signature:

Printed Printed
VENUS V. TAGARDA, MD. FE C. RETUERTAS
Name: Name:
Provincial Budget Officer
Position: Chief of Hospital II Position:
Head, Budget Unit / Authorized Representative

Date: December 2, 2015 Date:

 Republic of the Philippines
PROVINCIAL GOVERNMENT OF BUKIDNON
Provincial Capitol

NO.
DISBURSEMENT VOUCHER
Mode of
Check Cash Others
Payment
TIN/Employee No. Obligation Request No.
Payee Land Bank of the Philippines
RESPONSIBILITY CENTER
Address Malaybalay, Bukidnon Office/Unit/Project Code

EXPLANATION AMOUNT

Remittance of BPH-Maramag Job Order Employees for the Period 155,613.26

January 1 - 15, 2016
(Ababa, Djona Thes G. & Co.)

A Certified: B Certified:
Allotmant obligated for the purpose as
indicated above. Funds Available

Supporting documents completed.

Signature Signature

Printed Date Printed Date

RICHEL R. OKIT, CPA, MBA EFREN O. MONTESINO
Name Name
Provincial Accountant ICO - Provincial Treasurer
Position: Position:
Head, AccountingUnit/Authorized Representative Treasurer/Authorized Representative

C Approved for Payment D Received Payment

Check No. Bank Name Date
Signature

Printed
Signature
Name
Printed
Position:
Agency Head/Authorized Representative Name
OR/Other documents JEV NO. Date