Appendix 33

GENERAL PAYROLL

Entity Name : DepEd, Calbayog City Payroll No. : _______________________

Fund Cluster : _______________________________ Sheet _________of __________Sheets
We acknowledge receipt of cash shown opposite our name as full compensation for services rendered for the period covered. PROVIDENT LOAN 2024

DEDUCTIONS
Serial Net Amount Signature of
Name Position WITH PAG- Total
No. BS ACA LOAN AMOUNT LOAN BALANCE GS HOLDING PHIC ECIP Due Recipient
TAX IBIG Deduction

1 LYTTON A. ORTIZ AO II 28,512.00 100,000.00 50,000.00 50,000.00

2 ***Nothing Follows***
3
4
5 - - - - - -
6 - - - - - -
7 - - - - - -
8 - - - - - -
9 - - - - - -
10 - - - - -
28,512.00 - 100,000.00 50,000.00 - - - - - - 50,000.00
A CERTIFIED: Services duly rendered as stated. C APPROVED FOR PAYMENT: __________________________________
_______________________________(P )

GRACE S. PAGUNSAN MARGARITO A. CADAYON JR. PhD CESO VI

Administrative Officer V Date Assistant Schools Division Superintendent Date
Officer In-Charge
Signature over Printed Name of Authorized Official Office of the Schools Division Superintendent
B CERTIFIED: Supporting documents complete and proper; and cash available D CERTIFIED: Each employee whose name appears on the payroll has been paid the amount as E
in the amount of P______________________. indicated opposite his/her name ORS/BURS No. : _________

SHERYLL ANN MARIE G. LACABA, CPA Date : _______________

Accountant III Date SUZETTE P. CANDAZA JEV No. : ____________
(Signature over Printed Name) (Signature over Printed Name) Date Date : _______________
Head of Accounting Division/Unit CASHIER/Administrative Officer
CASHIER/Administrative Officer IV
IV
 Department of Education Fund Cluster :
Entity Name Division MOOE
Date :
DISBURSEMENT VOUCHER DV No. :

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

Payment
_________________

Payee ABEGAIL P. DIONISIO TIN/Employee No.: ORS/BURS No.:

Address

Responsibility
Particulars MFO/PAP Amount
Center

Payment of Provident loan of Abegail P. Dionisio. 50,000.00

Less: -

Amount Due 50,000.00

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

GRACE S. PAGUNSAN
Administrative Officer V

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)
Supp
proper

Signature Signature

Printed
Printed Name
Name SHERYLL ANN MARIE G. LACABA, CPA MARGARITO A. CADAYONA JR. PhD CESO VI
Accounting III Assistant Schools Division Superintendent
Head, Accounting Unit/Authorized Representative Officer In-Charge
Position Position
Office of the Schools Division Superintendent
Agency Head/Authorized Representative

Date Date

E. Receipt of Payment JEV No.

Check/ Bank Name & Account Number:
ADA No. : LANDBANK
Signature : Date : Printed Name: Date

Official Receipt No. & Date/Other Documents

92
 Annex A1

Organizational Code (UACS): 070010808009

NO:

OBLIGATION REQUEST AND STATUS DATE:

Fund Cluster:

Payee ABEGIAL P. DIONISIO

Office

Address Calbayog City

Resp.
Particulars P.P.A/MFO Account Code AMOUNT
Center

TO OBLIGATE PAYMENT OF PROVIDENT

loan of Abegail P. Dionisio.
50,000.00

Less:

Total 50,000.00

A. B.
Certified: Certified:
Charges to appropriation/allotment necessary, lawful / Allotment available and obligated for the
and under my direct supervision purpose as indicated above.
Supporting documents valid, proper and legal
Signatur
Signature
e
Printed Printed
Name
GRACE S. PAGUNSAN Name
SUNSHINE MARJORIE E. VENTURES

Administrative Officer V Admin. Officer V (Budget Officer III)

Position Position
Head, Requesting Office/Authorized Representative Head, Budget Unit/Authorized Representative
Date Date

C. STATUS OF OBLIGATION
Reference Amount
ORS/JEV/Check/ADA/TRA
Date Particulars No. Obligation Payment Payable Balance

P2 Brgy. Hamorawon, Calbayog City, Samar

(055) 530-0059 │ bit.ly/depedcalbayog
calbayogcity.division@deped.gov.ph