Annex 24 - Disbursement Voucher

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					                                                                                                                         Annex 24

                       DISBURSEMENT VOUCHER
                                                                                                                  DV No.:


                                                                                                                   Date:
                                                   LGU

                                             CLASSIFICATION OF DISBURSEMENT
            Cash Advance                                      Reimbursement                                      Other Payments
Name of Claimant:                                                                                                  ID No./TIN:


Address:                                                                                                           Responsibility
                                                                                                                   Center:

                                                 Particulars                                                                 Amount




                                                                                        Amount Due                P

A    Certified:                                   B    Completeness and propriety of supporting   C    Cash available:
     Expenses/Cash Advances necessary, lawful          documents/previous cash advance
     and incurred under my direct supervision.         liquidated/existence of funds held in
                                                       trust:




    Signature Over Printed Name/Position              Signature Over Printed Name/Position            Signature Over Printed Name/Position

D Approved For Payment: P_________                                                                E    Received Payment:

                                                        Payment:
                                                           Check No. _______________
                                                           Bank Name: _____________
                                                           Date: ___________________
Signature Over Printed Name/Position                                                              Signature Over Printed Name/Position


                                                                                                  JEV No.__________ Date________




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