Republic of the Philippines
Department of the Interior Local Government
BUREAU OF FIRE PROTECTION
REGIONAL HEADQUARTERS 4-A
4029 Camp Vicente Lim Calamba City Laguna
CALABARZON
DISBURSEMENT VOUCHER
Mode of Payment No:
MDS Check Commercial Check ADA Others Date:
Payee/ Office: TIN/ Employee Nr: OS/ BUS Nr :
Date:
Address: Responsibility Center Code
Fire Station Office/ Unit/ Project Code:
BATANGAS BFP R4A
Particulars Amount
To payment/ reimburse travel expenses incurred by (name of collecting officer),
__________________________fire station covering the period from APRIL 2010 to DECEMBER 2010
amounting to ___________________________________.
CERTIFICATION
This is to certify that the travel expense by the Collecting Officer, this station, has not yet been paid.
CFM/ MFM/ OIC
_________________Fire Station
Amount due: 0.00
A Certified: Supporting Documents complete and proper B Approved for Payment
Cash Available
Subject to ADA ( where available)
Signature: ____________________________________________ Signature: ____________________________________________
Printed Name: _________________________________________ Printed Name: _________________________________________
Position : _____________________________________________ Position : _____________________________________________
(Head, Accounting Unit/ Authorized Representative)
Date: ________________________________________________ Date: ________________________________________________
C Received Payment: Check/ ADA No: __________________ D Journal Entry Voucher:
Signature: ____________________________________________ Date: ___________________________
Printed Name: _________________________________________ Bank Name: ____________________ No: __________________________
Date: ________________________________________________
OR No. Other relevant document issued: Date: ________________________