OBLIGATION REQUEST AND STATUS

Serial No. : _____________________

Date : _________________________
_____________________________________
Entity Name Fund Cluster : ___________________

Payee JOHN JOMAR T. CORSIGA

Office SDO Masbate City
Address Jolly T. Fernandez Avenue, City of Masbate
UACS Object
Responsibility Center Particulars MFO/PAP Amount
Code
To obligate travel expenses per attached
supporting documents in the amount of ….
4,920.00

Total 4,940.00
A. Certified: Charges to appropriation/alloment are B. Certified: Allotment available and obligated
necessary, lawful and under my direct supervision;and for the purpose/adjustment necessary as
supporting documents valid, proper and legal indicated above

Signature : ___________________________________ Signature : ______________________________

FRANCISCO B. BULALACAO, JR. Printed Name: TERESA C. ARCAYERA

Position : Chief, CLMD Position : Supervising Administrative Officer

Head, Requesting Office/Authorized
Representative Head, Budget Division/Unit/Authorized Representative
Date : ___________________________________ Date : ____________________________

C. STATUS OF OBLIGATION
Reference Amount
Balance
ORS/JEV/Check/ Obligation Payable Payment Due and
Date Particulars Not Yet Due
ADA/TRA No. Demandable
(a) (b) (c) (a-b) (b-c)