Annex 14

Disbursement Voucher
Barangay: AKLE City/Municipality:SAN ILDEFONSO DV No: 2020-03-

Payee: Province:BULACAN DATE:

Address: AKLE, SIB Fund:
Amount

A. Certified as to B. Certified As to availability C.Certified as to validity,

availability of appropriation propriety, and legality of claim
for obligation completeness and propriety of and approved for payment
supporting documents

JENNIFER SULIT LORETO ANGELES VALERIANO DEL ROSARIO

(Signature Over Printed Name)
Chairman,Committee on
Appropriation
Date:_____________________
D. Accounting Entries
Account
(Signature Over Printed Name) (Signature Over Printed Name)
Barangay Treasurer Punong Barangay
Date:_____________________ Date:_____________________
Account Code Debit Credit

cash in bank 1-01-02-010

- -
E.Received Payment: Check No.:__ _
Bank Name:____PVB____ DATE:
OR No.:__________________
Signature Over Printed Name
 PURCHASE REQUEST
Barangay: AKLE P.R. No.:
City/Municipality: San Ildefonso Date:
REQUISITION
Item Unit of Estimated Estimated
Number QTY Measurement Item Description Unit Cost Amount

Total Estimated Amount P -

Purpose:
Requested by: Approved:

VALERIANO DEL ROSARIO VALERIANO DEL ROSARIO

Signature over Printed Name Signature over Printed Name
Requisitioner Requisitioner

____________ ______________
Date Date
 PURCHASE ORDER
Barangay: AKLE City/Municipality : San Ildefonso
Tel. No. Province: Bulacan
Supplier: P.O. No.
Address Date:
Mode of Procurement:
TIN: Bidding Negotiated Over the Counter
Gentlemen: Please deliver to this office the following articles subject to the terms and conditions contained herein.
Place of Delivery: Delivery Term:
Date of Delivery: Payment Term:
Unit Particulars Quantity Unit Cost Amount

(Total Amount in words) ### -

Very truly yours,

In Case of failure to make full delivery within the VALERIANO DEL ROSARIO
time specified above, a penalty of one-tenth (1/10) Signature over Printed Name
of one percent for everyday of delay shall be imposed. Punong Barangay
Date : ________________
Conforme:
Existence of Available Appropriations of

JENNIFER SULIT
Signature over Printed name Signature over Printed name

Date: ___________ Date: ______________

 Republic of the Philippines
Province of Bulacan
Municipality of San Ildefonso
OFFICE OF THE BARANGAY AKLE

Date:

Please quote your prices for the purchase of numerated below to be used

QUANTITY UNIT DESCRIPTION Unit Price TOTAL

-
-
-
-
-
-
-
-
-
-
-

CANVASSED BY: LORETO ANGELES

APPROVED BY: VALERIANO DEL ROSARIO

The Barangay Treasurer
San Ildefonso, Bulacan
Sir,
The above mentioned prices is offer by our establishment.

Date Supplier Signature

 Republic of the Philippines
Province of Bulacan
Municipality of San Ildefonso
OFFICE OF THE BARANGAY AKLE

RESULT OF CANVASS

Date:

To Whom It May Concern:

We the undersigned Brgy. Captain, Brgy. Treasurer and Brgy. Secretary hereby certify that
pursuant to Republic Act No. 2204 canvassed the said materials mentioned in the letter of request of
the barangay treasurer to the different establishment dated or the purchase of

Result of canvass made as follows:

1 P
2
3
The order of award was given to

VALERIANO DEL ROSARIO

Barangay Captain

LORETO ANGELES JULIAVHER FRAILON

Barangay Treasurer Barangay secretary
 ACCEPTANCE AND INSPECTION REPORT
Barangay: AKLE City/Municipality: SAN ILDEFONSO
Tel: Province: BULACAN

Supplier: Invoice No. AIR No: RIS NO.

PO No. Date: Date: Date:
Date:
Unit Description Quantity

ACCEPTANCE INSPECTION

Date Inspected:

Complete Inspected, verified as to quantity and

specifications

Partial(Pls. Specify quantity received)

Signature over Printed Name Signature over Printed Name

Barangay Treasurer Authorized Inspector
 JANUARY 29, 2020

LUZVIMINDA V. RIVERA 10,000.00

TEN THOUSAND PESOS ONLY

VALERIANO DEL ROSARIO LORETO ANGELES

BARANGAY CAPTAIN BARANGAY TREASURER
 Barangay AKLE
City /Municipality San Ildefonso
Province of Bulacan

PUNONG BARANGAY'S CERTIFICATION (PBC)

(FOR BARANGAY CHECK DISBURSEMENTS)

PBC No. 2020-BRGY.AKLE -

Date:
To: The Bank Manager: Ms. Susan R. De Mesa
Phil. Veterans Bank
Baliuag Branch

Sir/Madam:

This is to certify that thefollowing checks were duly issued by Barangay AKLE complete with respective
Disbursement Vouchers and supporting documents.

Account No. Check No. Date Payee Amount Purpose

0053-001950-001

TOTAL -

This Certification is issued, pursuant to COA Circular 2019-001 dated, January 30, 2019
as a condition for the encashment of said checks.
The undersigned attests to the truthfulness of the foregoing facts, under the pain of liability for falsification,
pursuant to Article 171 (4) of the Revised Penal Code.

Very truly yours,

VALERIANO DEL ROSARIO

Punong Barangay

Delivered by. Received By:

LORETO ANGELES ___________________________

Barangay Treasurer Bank Representative
Date:_______________________ Date:___________________________