Appendix 32

Fund Cluster :

Date :
DISBURSEMENT VOUCHER DV No. :

Mode of MDS Check Commercial Check ADA Others (Please specify) _____________
Payment Code:

TIN/Employee No.: ORS/BURS No.:

Payee

Address

Responsibility
Particulars MFO/PAP Amount
Center

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

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)
Supporting documents complete and amount claimed
proper

Signature Signature

Printed
Printed Name
Name

Position Position

Date Date

E. Receipt of Payment JEV No.

Date : Bank Name & Account Number:
Check/
ADA No. :

Date : Printed Name: Date

Signature :

Official Receipt No. & Date/Other Documents