Republic of the PhilippinesQUEZON CITY GOVERNMENT

Quezon Memorial Circle, Diliman, Quezon City

DISBURSEMENT VOUCHERNO.

Mode of Payment

Check Cash Others

PayeeTIN/Employee No. Obligation Request No.

Address

Responsibility Center

Office/Unit/Project Code

EXPLANATION AMOUNT

A. Certified

Allotment obligated for the purpose as indicated above

Supporting documents complete

B. Certified

Funds Available

Signature Signature

Printed Name EDITHA ALZONADate

Printed Name VICTOR B. ENDRIGADate

Position City Accountant

City Accountant/ Authorized Representative

Position City Treasurer

City Treasurer/Representative

C. Approved for Payment D. Received Payment

SignatureCheck No. Bank Name Date

Printed Name HON. FELICIANO R. BELMONTE, JR. Date

Signature

Printed Name Date

Position

City Mayor

City Mayor or City Administrator

OR/Other Documents

JEV No. Date