Proposed

REPORT OF CHECKS ISSUED

01/28
Period Covered: ________________
2014-01-028
Agency : JDG Department Report No.: ___________
Fund : 01 1234
Bank Name/Account No. _________________ 1
Sheet No.: _______________
Check DV No. / ORS/BUR Responsibility UACS Code/
Payee MFO/PAP/KRA Amount
Date No. Payroll No. Center Code Expenditure
1/28 023 2014-02-010 010 26-036-00-00000 ABC Corporation 3 01 01 0000 50604050 03 44,000 00
123

44,000 00

CERTIFICATION
I hereby certify that this Report of Checks Issued (RCI) in _________ sheet(s) is a full,
true and correct statement of all checks issued by me in payment for obligations for the period stated and
shown in the attached disbursement vouchers.
AO 6/15/02

Juan dela Cruz 01/29/14

Disbursing Date
Officer
 AGENCY X, REGIONAL OFFICE NO. VIII Fund Cluster :
Date :
Entity Name Novembe r 10101
2, 2016 March 1, 2019
DISBURSEMENT VOUCHER DV No. : 2019-03-0000 Should be fill out according to the information specifically provided for each transaction
2016-11-
573 Must be shown in all disbursement vouchers
Mode of MDS Check Commercial Check ADA Others (Please specify)
P ayment
_________________ At your discretion ; you may input information of your desire unless specifically given in the problem
TIN/Employee No.: ORS No..:
Payee HEAD DIVISION
000-746-621-000 01-101101-2019-01-00001

Address Tacloban City

Particulars Responsibility Center MFO/PAP Amount

Payment of Representation Allowance and 23-001-20-00008 MFO 3 17,000.00

Transportation Allowance for the Regional Regulations of Public
Director of the office for the month of March,
2019. Transport Services
3 03 00 0000

Amount Due 17,000.00

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

Lhalaine Tubes

Administrative OfficerV

B. Accounting Entry:
Account Title UACS Code Debit Credit

Representation Allowance 5010202000 8,500.00

Transportation Allowance 5010203000 8,500.00
Cash - MDS, Regular 1010404000 17,000.00
17,000.00 17,000.00
C. Certified: Expense Code/s forACIC / LDDAP-ADA
Cash available
5010202000 17,000.00
Subject to Authority to Debit Account (when applicable) 5010203000

Sup
proper
D. Approved for Payment
Signature Signature

Printed
Kyra Mae Poria Printed Name Christian Peliño
Name
Position Accountant II Position Regional Director

Date Date
E. Receipt of Payment JEV No.
Check/ADA Date : Bank Name & Account Number:
N o. :
Date : Date
Signature : HEAD DIVISION

Official Receipt No. & Date/Other Documents NCA No.: -0000 672

AGENCY X, REGIONAL OFFICE NO. VIII Fund Cluster :

Entity Name November 10101
2, 2016 March 3, 2019
DISBURSEMENT VOUCHER DV No. : 2019-03-0000
2016-11-
573
Mode of MDS Check Commercial Check ADA Others (Please specify)
P ayment
_________________
TIN/Employee No.: ORS No..:
Payee VISION SECURITY SERVICES, INC.
000-746-621-000 01-101101-2019-01-00001

Address Tacloban City

Particulars Responsibility Center MFO/PAP Amount

Paid gasoline expenses for the month of 23-001-20-00008 MFO 3 20,000.00

February, 2019. Regulations of Public
Transport Services
3 03 00 0000

Amount Due 20,000.00

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

Lhalaine Tubes

Administrative OfficerV

B. Accounting Entry:
Account Title UACS Code Debit Credit

Fuel, Oil and Lubricants Expenses 5020309000 20,000.00

Due to BIR 2020101000 3,000.00
Cash - MDS, Regular 1010404000 17,000.00
20,000.00 20,000.00
C. Certified: Expense Code/s forACIC / LDDAP-ADA
Cash available
5020309000 20,000.00
Subject to Authority to Debit Account (when applicable)

Sup
proper
D. Approved for Payment
Signature Signature
Printed
Kyra Mae Poria Printed Name Christian Peliño
Name
Position Accountant II Position Regional Director

Date Date
E. Receipt of Payment JEV No.
Check/ADA Date : Bank Name & Account Number:
N o. :
Date : Date
Signature : VISION SECURITY SERVICES, INC.

Official Receipt No. & Date/Other Documents NCA No.: -0000 672

AGENCY X, REGIONAL OFFICE NO. VIII Fund Cluster :

Date :
Entity Name Novembe r 10101
2, 2016 March 4, 2019
DISBURSEMENT VOUCHER DV No. : 2019-03-0000
2016-11-
573
Mode of MDS Check Commercial Check ADA Others (Please specify)
P ayment
_________________
TIN/Employee No.: ORS No..:
Payee PHILIPPINE POST
000-746-621-000 01-101101-2019-01-00001

Address Tacloban City

Particulars Responsibility Center MFO/PAP Amount

Remittance of employee share and employeer 23-001-20-00008 MFO 3 97,768.35

share of mandatory contributions to GSIS, Regulations of Public
PhilHealth and Pag-IBIG for the month of
January, 2019. Transport Services
3 03 00 0000

Amount Due 97,768.35

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

Lhalaine Tubes

Administrative OfficerV

B. Accounting Entry:
Account Title UACS Code Debit Credit

Retirement and Life Insurance Premium 5010301000 49,869.84

PhilHealth Contribution 5010303001 4,248.06
Pag-IBIG Contribution 5010302001 1,000.00
Due to GSIS 2020102000 37,402.38
Due to PhilHealth 2020104000 4,248.06
Due to Pag-IBIG 2020103000 1,000.00
Cash - MDS, Regular 1010404000 97,768.35
97,768.35 97,768.35
C. Certified: Expense Code/s forACIC / LDDAP-ADA
Cash available 5010301000
5010303001 97,768.35
Subject to Authority to Debit Account (when applicable) 5010302001
2020102000
Sup 2020104000
proper 2020103000
D. Approved for Payment

Signature Signature
Printed
Kyra Mae Poria Printed Name Christian Peliño
Name
Position Accountant II Position Regional Director

Date Date
E. Receipt of Payment JEV No.
Check/ADA Date : Bank Name & Account Number:
N o. :
Date : Date
Signature : PHILIPPINE POST

Official Receipt No. & Date/Other Documents NCA No.: -0000 672

AGENCY X, REGIONAL OFFICE NO. VIII Fund Cluster :

Date :
Entity Name Novembe r 10101
2, 2016 March 5, 2019
DISBURSEMENT VOUCHER DV No. : 2019-03-0000
2016-11-
573
Mode of MDS Check Commercial Check ADA Others (Please specify)
P ayment
_________________
TIN/Employee No.: ORS No..:
Payee
000-746-621-000 01-101101-2019-01-00001
Address Tacloban City

Particulars Responsibility Center MFO/PAP Amount

Paid for security services rendered by Vision 23-001-20-00008 MFO 3 30,000.00

Security Services, Inc. for the month of Regulations of Public \
February, 2019
Transport Services
3 03 00 0000

Amount Due 30,000.00

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

Lhalaine Tubes

Administrative OfficerV

B. Accounting Entry:
Account Title UACS Code Debit Credit

Security Services 5021203000 30,000.00

Due to BIR 2020101000 ###
Cash - MDS, Regular 1010404000 23,000.00
30,000.00 30,000.00
C. Certified: Expense Code/s forACIC / LDDAP-ADA
Cash available
5021203000 30,000.00
Subject to Authority to Debit Account (when applicable)

Sup
proper
D. Approved for Payment
Signature Signature

Printed
Kyra Mae Poria Printed Name Christian Peliño
Name
Position Accountant II Position Regional Director

Date Date
E. Receipt of Payment JEV No.
Check/ADA Date : Bank Name & Account Number:
N o. :
Date : Date
Signature : 0

Official Receipt No. & Date/Other Documents NCA No.: -0000 672

AGENCY X, REGIONAL OFFICE NO. VIII Fund Cluster :

Date :
Entity Name Novembe r 10101
2, 2016 March 7, 2019
DISBURSEMENT VOUCHER DV No. : 2019-03-0000
2016-11-
573
Mode of MDS Check Commercial Check ADA Others (Please specify)
P ayment
_________________
TIN/Employee No.: ORS No..:
Payee LMWD
000-746-621-000 01-101101-2019-01-00001
Address Tacloban City

Particulars Responsibility Center MFO/PAP Amount

Paid water expenses from LMWD of water bill 23-001-20-00008 MFO 3 8,600.00
for month of February, 2019. Regulations of Public
Transport Services
3 03 00 0000

Amount Due 8,600.00

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

Lhalaine Tubes

Administrative OfficerV

B. Accounting Entry:
Account Title UACS Code Debit Credit

Water Expenses 5020401000 8,600.00

Due to BIR 2020101000 800.00
Cash - MDS, Regular 1010404000 7,800.00
8,600.00 8,600.00
C. Certified: Expense Code/s forACIC / LDDAP-ADA
Cash available
5020401000 8,600.00
Subject to Authority to Debit Account (when applicable)

Sup
proper
D. Approved for Payment
Signature Signature
Printed
Kyra Mae Poria Printed Name Christian Peliño
Name

Position Accountant II Position Regional Director

Date Date
E. Receipt of Payment JEV No.
Check/ADA Date : Bank Name & Account Number:
N o. :
Date : Date
Signature : LMWD

Official Receipt No. & Date/Other Documents NCA No.: -0000 672

AGENCY X, REGIONAL OFFICE NO. VIII Fund

Date :Cluster :
Entity Name Novembe r 10101
2, 2016 March 8, 2019
DISBURSEMENT VOUCHER DV No. : 2019-03-0000
2016-11-
573
Mode of MDS Check Commercial Check ADA Others (Please specify)
P ayment
_________________
TIN/Employee No.: ORS No..:
Payee LEYECO II
000-746-621-000 01-101101-2019-01-00001

Address Tacloban City

Particulars Responsibility Center MFO/PAP Amount

Paid electricity expenses from LEYECO II of 23-001-20-00008 MFO 3 12,500.00

electric bill for month of February, 2019. Regulations of Public
Transport Services
3 03 00 0000

Amount Due 12,500.00

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

Lhalaine Tubes

Administrative OfficerV

B. Accounting Entry:
Account Title UACS Code Debit Credit

Electricity Expenses 5020402000 12,500.00

Due to BIR 2020101000 ###
Cash - MDS, Regular 1010404000 10,900.00
12,500.00 12,500.00
C. Certified: Expense Code/s forACIC / LDDAP-ADA
Cash available
5020402000 12,500.00
Subject to Authority to Debit Account (when applicable)

Sup
proper
D. Approved for Payment

Signature Signature
Printed
Kyra Mae Poria Printed Name Christian Peliño
Name
Position Accountant II Position Regional Director

Date Date
E. Receipt of Payment JEV No.
Check/ADA Date : Bank Name & Account Number:
N o. :
Date : Date
Signature : LEYECO II

Official Receipt No. & Date/Other Documents NCA No.: -0000 672
 AGENCY X, REGIONAL OFFICE NO. VIII Fund Cluster :
Date :
Entity Name Novembe r 10101
2, 2016 March 15, 2019
DISBURSEMENT VOUCHER DV No. : 2019-03-0000
2016-11-
573
Mode of MDS Check Commercial Check ADA Others (Please specify)
P ayment
_________________
TIN/Employee No.: ORS No..:
Payee LAND BANK OFTHE PHILIPPINES
000-746-621-000 01-101101-2019-01-00001

Address Tacloban City

Particulars Responsibility Center MFO/PAP Amount

Granting of cash advance covering the period 23-001-20-00008 MFO 3 173,084.49

of March 1-15, 2019 thorugh LDDAP-ADA. Regulations of Public
Transport Services
3 03 00 0000

Amount Due 173,084.49

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

Lhalaine Tubes

Administrative OfficerV

B. Accounting Entry:
Account Title UACS Code Debit Credit

Advances for Payroll 1990102000 173,084.49

Cash - MDS, Regular 1010404000 173,084.49
173,084.49 173,084.49
C. Certified: Expense Code/s forACIC / LDDAP-ADA
Cash available
1990102000 173,084.49
Subject to Authority to Debit Account (when applicable)

Sup
proper
D. Approved for Payment
Signature Signature
Printed
Kyra Mae Poria Printed Name Christian Peliño
Name
Position Accountant II Position Regional Director

Date Date
E. Receipt of Payment JEV No.
Check/ADA Date : Bank Name & Account Number:
N o. :
Date : Date
Signature : LAND BANK OF THE PHILIPPINES

Official Receipt No. & Date/Other Documents NCA No.: -0000 672

AGENCY X, REGIONAL OFFICE NO. VIII Fund Cluster :

Date :
Entity Name Novembe r 10101
2, 2016 March 17, 2019
DISBURSEMENT VOUCHER DV No. : 2019-03-0000
2016-11-
573
Mode of MDS Check Commercial Check ADA Others (Please specify)
P ayment
_________________
TIN/Employee No.: ORS No..:
Payee TOYOTA,INC.
000-746-621-000 01-101101-2019-01-00001

Address Tacloban City

Particulars Responsibility Center MFO/PAP Amount

Payment for the repair of motor vehicle to 23-001-20-00008 MFO 3 10,000.00

Toyota Inc. Regulations of Public
Transport Services
3 03 00 0000

Amount Due 10,000.00

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

Lhalaine Tubes

Administrative OfficerV

B. Accounting Entry:
Account Title UACS Code Debit Credit

Motor Vehicle 5021306001 10,000.00

Due to BIR 2020101000 ###
Cash - MDS, Regular 1010404000 8,000.00
10,000.00 10,000.00
C. Certified: Expense Code/s forACIC / LDDAP-ADA
Cash available
5021306001 10,000.00
Subject to Authority to Debit Account (when applicable)

Sup
proper
D. Approved for Payment
Signature Signature
Printed
Kyra Mae Poria Printed Name Christian Peliño
Name

Position Accountant II Position Regional Director

Date Date
E. Receipt of Payment JEV No.
Check/ADA Date : Bank Name & Account Number:
N o. :
Date : Date
Signature : TOYOTA,INC.

Official Receipt No. & Date/Other Documents NCA No.: -0000 672

AGENCY X, REGIONAL OFFICE NO. VIII Fund Cluster :

Date :
Entity Name Novembe r 10101
2, 2016 March 22, 2019
DISBURSEMENT VOUCHER DV No. : 2019-03-0000
2016-11-
573
Mode of MDS Check Commercial Check ADA Others (Please specify)
P ayment
_________________
TIN/Employee No.: ORS No..:
Payee PETTY CASH CUSTODIAN
000-746-621-000 01-101101-2019-01-00001

Address Tacloban City

Particulars Responsibility Center MFO/PAP Amount

Replenishment of petty cash fund upon receipt 23-001-20-00008 MFO 3 10,500.00

of Report of Paid Petty Cash Vouchers, Regulations of Public
supported by petty cash vouchers, official
receipts and other supporting documents. Transport Services
3 03 00 0000

Amount Due 10,500.00

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

Lhalaine Tubes

Administrative OfficerV

B. Accounting Entry:
Account Title UACS Code Debit Credit

Office Supplies Expenses 5020301000 1,800.00

Other Supplies and Materials Expenses 5020399000 2,600.00
Representation Expenses 5029903000 4,500.00
Fuel, Oil and Lubricant Expenses 5020309000 1,600.00
Cash - MDS, Regular 1010404000 10,500.00
10,500.00 10,500.00
C. Certified: Expense Code/s forACIC / LDDAP-ADA
Cash available
5020301000 10,500.00
Subject to Authority to Debit Account (when applicable) 5020399000
5029903000
Sup 5020309000
proper
D. Approved for Payment
Signature Signature

Printed Kyra Mae Poria Printed Name Christian Peliño

Name
Position Accountant II Position Regional Director

Date Date
E. Receipt of Payment JEV No.
Check/ADA Date : Bank Name & Account Number:
N o. :
Date : Date
Signature : PETTY CASH CUSTODIAN

Official Receipt No. & Date/Other Documents NCA No.: -0000 672

AGENCY X, REGIONAL OFFICE NO. VIII Fund Cluster :

Date :
Entity Name Novembe r 10101
2, 2016 March 28, 2019
DISBURSEMENT VOUCHER DV No. : 2019-03-0000
2016-11-
573
Mode of MDS Check Commercial Check ADA Others (Please specify)
P ayment
_________________
TIN/Employee No.: ORS No..:
Payee LAND BANK OFTHE PHILIPPINES
000-746-621-000 01-101101-2019-01-00001

Address Tacloban City

Particulars Responsibility Center MFO/PAP Amount

Granting of cash advance covering period of 23-001-20-00008 MFO 3 173,084.49

March 16-31,2019 through LDDAP-ADA. Regulations of Public
Transport Services
3 03 00 0000

Amount Due 173,084.49

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

Lhalaine Tubes

Administrative OfficerV

B. Accounting Entry:
Account Title UACS Code Debit Credit

Advances for Payroll 1990102000 173,084.49

Cash - MDS, Regular 1010404000 173,084.49
173,084.49 173,084.49
C. Certified: Expense Code/s forACIC / LDDAP-ADA
Cash available
1990102000 173,084.49
Subject to Authority to Debit Account (when applicable)

Sup
proper
D. Approved for Payment
Signature Signature

Printed Kyra Mae Poria Printed Name Christian Peliño

Name
Position Accountant II Position Regional Director

Date Date
E. Receipt of Payment JEV No.
Check/ADA Date : Bank Name & Account Number:
N o. :
Date : Date
Signature : LAND BANK OF THE PHILIPPINES

Official Receipt No. & Date/Other Documents NCA No.: -0000 672