Republic of the Philippines

DEPARTMENT OF JUSTICE
BUREAU OF CORRECTIONS
NBP Reservation, Muntinlupa City, Philippines, 1776
Telefax: +632-809-80-73

Fund Cluster :

DISBURSEMENT VOUCHER Date : 2/11/2019

DV No. :

Mode of MDS Check Commercial Check ADA Others (Please specify)

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee CSO1 CHARLITO D. BUSTILLO

Address MUNTINLUPA CITY

Responsibility
Particulars MFO/PAP Amount
Center

Reimbursment of expenses for gasoline

as per A.O. NO. 017-S-2019, 021-S-2019 and 045-s-
2019
1,500.00

Amount Due 1,500.00

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

CINSP ALEX M. HIZOLA

B. Accounting Entry:
Account Title UACS Code Debit Credit

C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Sup
proper

Signature Signature

Printed
Printed Name
Name JONNEL CESAR A. LAT USEC NICANOR E. FAELDON

Director General BUCOR

Position Chief Accounting Division Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative

Date Date

E. Receipt of Payment JEV No.

Check/ Date : Bank Name & Account Number:
ADA No. : DBM Acct no. 5-03050-430-4
Date : Printed Name: Date
Signature :
CHARLITO D. BUSTILLO
Official Receipt No. & Date/Other Documents

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