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REIMBURSEMENT/LIQUIDATION FORM

NAME: JOHN URBANOZO DATE: September 17, 2023

POSITION: SERVICE ENGINEER PERIOD: Sept. 1-17 2023

DATE
(mm/dd/yy) ACCOUNTS PARTICULARS AMOUNT
09/04/23 CERVANTES 4,882.00
TAGUDIN
09/05/23 KARMELLI LAOAG
09/06/23 NARVACAN DISTRICT 4,650.00
09/07/23 MAGSINGAL DISTRICT
MILAGROSA SINAIT
UNP-VIGAN
GABRIELA SILANG HOSP.
NARVACAN DISTRICT
UNP-VIGAN
09/08/23 ABRA PROVINCIAL
ASSUMPTA ABRA 4,110.00
09/11/23 KARMELLI LAOAG
09/12/23 NORTH WESTERN UNI.
09/14/23 NARVACAN DISTRICT 4,000.00

TOTAL 17,642.00

LESS: GAS ALLOWANCE 4,000.00

REIMBURSEMENT: 13,642.00

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