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Republika ng Pilipinas KAGAWARAN NG KATARUNGAN Department of Justice Manila DEPARTMENT CIRCULAR No. To: Undersecretaries and Assistant Secretaries Chiefs of Service/ Staff in the Office of the Secretary Regional/Provincial/ City Prosecutors All Concerned Subject: Preparation of Obligation Request and Status and Disbursement Voucher Date: 8 June 2016 In the interest of speedy processing of disbursement transactions and to ensure uniform implementation of Department Circular No. 002 dated 12 January 2016 mandating the use of the revised forms of Obligation Request and Status (ORS) and Disbursement Voucher (DV) prescribed under the new Government Accounting Manual (GAM), everyone is strictly enjoined to observe the following: The requesting unit/originating party shall prepare the ORS and DV in four (4) copies; The head/supervisor of the requesting office or program shall sign box A of the ORS and box A of the DV; and The complete documents based on the Checklist of Requirements should be submitted in support of the disbursement transaction. Attached, for information and reference, are copies of pertinent GAM Procedures for Disbursement, Program/Activity/Project Codes, and List of Responsibility Centers. W e EMMAN . CAPARAS ..0-- Secreta ii, Department of Justice I I CN i 0201606276 Illil ll RIM nillill 028

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Republika ng Pilipinas KAGAWARAN NG KATARUNGAN

Department of Justice

Manila

DEPARTMENT CIRCULAR No.

To:

Undersecretaries and Assistant Secretaries Chiefs of Service/ Staff in the Office of the Secretary Regional/Provincial/ City Prosecutors All Concerned

Subject: Preparation of Obligation Request and Status and Disbursement Voucher

Date: 8 June 2016

In the interest of speedy processing of disbursement transactions and to ensure uniform implementation of Department Circular No. 002 dated 12 January 2016 mandating the use of the revised forms of Obligation Request and Status (ORS) and Disbursement Voucher (DV) prescribed under the new Government Accounting Manual (GAM), everyone is strictly enjoined to observe the following:

The requesting unit/originating party shall prepare the ORS and DV in four (4) copies;

The head/supervisor of the requesting office or program shall sign box A of the ORS and box A of the DV; and

The complete documents based on the Checklist of Requirements should be submitted in support of the disbursement transaction.

Attached, for information and reference, are copies of pertinent GAM Procedures for Disbursement, Program/Activity/Project Codes, and List of Responsibility Centers.

We EMMAN . CAPARAS ..0-- Secreta ii, Department of Justice

I I CN i 0201606276

Illil ll RIM nillill

028

cancelled checks shall be recorded chronologically in the Checks and ADA Disbursements Record (CkADADRec) (Appendix 34) maintained by the Cash/Treasury Unit. The dates the checks were actually released shall be indicated in the appropriate column provided for in the CkADADRec. All checks/ADA drawn whether released or unreleased shall be included in the Report of Checks Issued (RCI) (Appendix 35) or Report of ADA Issued (RADA') (Appendix 13), which shall be prepared daily by the Cashier. The RCURADAI together with the original copies of the supporting documents (SDs) shall be submitted to the Accounting Division/Unit for the preparation of JEV (Appendix 36). At the end of the year, a Schedule of Unreleased Commercial Checks shall be prepared by the Cashier for submission to the Accounting Division/Unit. The adjusting accounting entries for umeleased commercial checks are presented in Sec. 56 of Chapter 19-Financial Reporting of this Manual.

Sec. 11. Recording of Check Disbursements by Field Offices without Complete Set of Books. Field Offices (F0s) without complete set of books shall record chronologically in the Cash in Bank Register (CBReg) (Appendix 37) all checks issued/charged to deposits with the AGDB. The certified copy of the CBReg together with the required SDs shall be submitted within five days after the end of each month to the concerned mother unit (central/regional/division office) by the FOs (a unit under the central/regionaU division office) for review and recording of the transactions in the books of accounts.

Sec. 12. Procedures for Disbursements by Checks

Area of Responsibility

Seq. No.

Activity

Preparation of DV Requesting Office/Unit

Designated 1 Prepares the DV in four copies in accordance with the Staff instructions on the preparation of the DV (Appendix 32) to

initiate the payment of claims. Forwards the DVs, SDs and ORS to the Budget Division/Unit for processing.

Note 1 — The procedures on processing/approval of ORS are discussed in Sec. 15, Chapter 3 of this Manual.

Processing of DV Accounting Division/Unit

Receiving/ 2 Receives Copies 1-4 of DV, SDs and Copies 2-3 of ORS Releasing Staff from the Budget Division/Unit. Checks completeness of

SDs based on the checklist. If incomplete, returns to the party concerned for compliance.

If complete, stamps "Received" and indicates date of receipt and initials on the stamped "Received" portion of the DV.

Note 2 — Copy I of the ORS shall be retained by the Budget Unit which shall serve as the subsidiary ledger of obligations.

3 Assigns DV number and records in the logbook the DV number and date, creditor/payee, particular and amount.

66

Area of Responsibility

Seq. No.

Activity

Forwards Copies 1-4 of DV, SDs and Copies 2-3 of ORS to the designated Staff for processing.

Note 3 — The numbering structure for DV shall be as follows:

00 - 0000 - 00 - 000000

0. Serial Number (One Series per Fund Cluster for each year)

0' Month of Issue

0 Year of Issue

Fund Cluster Code

Note 4— DV number shall also be indicated on every sheet of the SDs.

Designated 4 Receives Copies 1-4 of DV, SDs and Copies 2-3 of ORS Staff/ from the Receiving/Releasing Staff. Reviews DV for Processing completeness and propriety of SDs. Staff

5 Retrieves Index of Payments (IoP) (Appendix 38) from file and determines if claim is in order. If with prior payment on the same claim, returns the DV, SDs and ORS informing the requesting office/party of prior payment made. If in order, verifies ORS against DV. If the amounts in the ORS and DV are the same, records the following in the IP: DV date and number, particulars and amount and proceeds to Activity No. 9. For first-time claimant, prepares IP and records the name, address, employee number and/or TIN, DV date, particulars and amount. If the amounts in the ORS and DV differ, prepares NORSA in three copies and signs the "Prepared by" portion. Forwards Copies 1-3 of NORSA, Copies 1-4 of DV, Copies 2-3 of ORS and SDs to the Head of Accounting Division/Unit for approval of the NORSA.

Head of 6 Signs the "Approved by" portion of the NORSA. Accounting Division/Unit/ Authorized Officer

Receiving/ 7 Records in the logbook the return of Copies 1-3 of Releasing Staff NORSA, Copies 1-4 of DV, Copies 2-3 of ORS and SDs

to the Budget Unit for correction of obligation.

67

Area of Responsibility

Seq. No.

Activi tY

Budget Division/Unit

Designated Staff

Accounting Division/Unit

Designated Staff

Head of the Accounting Division/Unit/ Authorized Officer

Receiving/ Releasing Staff

Office of the Agency Head/Authorized Representative

Receiving/ Releasing Staff

Approving Officer

8 Posts the NORSA in the 'Obligation' column of Section C of the ORS. If the original amount is lesser than the actual obligation, a positive entry corresponding to additional obligation shall be recorded in the RAOD based on the NORSA. If the original obligation is greater, a negative entry representing the excess shall be recorded in the RAOD. Returns Copies 2-3 of NORSA, Copies 1-4 of DV, Copies 2-3 of ORS and SDs to the Accounting Division/Unit for processing. Files Copy 2 of NORSA together with the original copy of the ORS.

9 Initials in Box B of DV and forwards Copies 1-4 of DV and SDs, Copies 2-3 of ORS to the Head of Accounting Division/Unit/Authorized Officer for review.

Note 5 — In case there is NORSA attached to the DV, it shall be included among the SDs of the DV.

10 Retrieves the RANCA/RANTA from file and determines availability of NCA. If NCA is sufficient to cover the disbursement, records in the RANCAJRANTA the DV date and number, and amount under the 'Utilized' column and indicates NCA balance. Otherwise, notes that cash is not yet available and returns the DV and SDs to the Designated Staff for safekeeping.

II Checks the "Cash available" portion in Box B of the DV.

12 Reviews DV and SDs. Signs Box B of DV. Forwards the documents to the Receiving/Releasing Staff.

13 Records in the logbook the release of Copies 1-4 of DV and SDs and Copies 2-3 of ORS to the Head of Agency or Authorized Representative for approval of the DV.

14 Receives Copies 1-4 of DV, SDs and Copies 2-3 of ORS and records in the logbook the date of receipt. Forwards the set of documents to the Approving Officer for review and approval.

15 Reviews DV and signs in Box C "Approved for Payment" portion. Forwards Copies 1-4 of DV, Copies 2-3 of the ORS and SDs.

68

Area of Seq. I Responsibility No.

, • • Activity

Note 6 — Depending on the set up/procedures of agencies, review of the claims may be done by authorized personnel/staff prior to the approval of the Head of the Agency or his/her , Authorized Representative.

Receiving/ 16 Records in logbook the approved DV and all SDs and Releasing Staff forwards the documents to the Cash/Treasury Unit.

Preparation and Approval of Cheeks Cash/Treasury Unit

Receiving/ 17 Receives Copies 1-4 of approved DV, Copies 2-3 of ORS Releasing Staff and SDs. Records in the logbook the date of receipt, DV

number, payee, particulars and amount.

Designated 18 Checks completeness of signatories on the DV. Prepares Staff check in three copies.

19 Retrieves from file the ClcADADRec maintained per bank account and records the date, check number, name of payee, nature of payment and amount of the DV and indicates the new balance of the NCA/bank account. Forwards Copies 1-3 of check, Copies 1-4 of DV, Copies 2-3 of ORS and SDs to the Cashier/Head of Cash/Treasury Unit for review and signature.

Note 7 — For field offices without complete set of books, the CBReg shall be maintained.

Cashier or 20 Verifies completeness of signature on the DV. Reviews Head of Cash/ the amount of the check against the DV and SDs. Signs Treasury Unit the check.

Receiving/ 21 Records in the logbook the date of submission to the Releasing Staff approving authority of Copies 1-3 of check, Copies 1-4 of

DV, Copies 2-3 of ORS and SDs.

Office of the Agency Head/Authorized Representative

Receiving/ 22 Records in the logbook the date of receipt of Copies 1-3 of Releasing Staff check, Copies 1-4 of DV, Copies 2-3 of ORS and SDs.

Forwards the set of documents to the Authorized Countersigning Official.

Authorized 23 Countersigns the check. Forwards Copies 1-3 of check, Official Copies 1-4 of DV, Copies 2-3 of ORS and SDs to the

Receiving/Releasing Staff for return to the Cashier/Head of Cash/Treasury Unit.

69

Responsibility No. Seq. Area of

Cash/Treasury Unit

Cashier 25 Receives Copies 1-3 of check, Copies 1-4 of DV, Copy 2- 3 of ORS and SDs and checks completeness of signatures in the check. Retrieves the CkADADRec and notes the return of the signed and countersigned check.

Cashier 26 Releases the original of check and Copy 4 of DV to the payee. Attaches OR/Invoice issued by payee/claimant, if any on Copy 1 of DV and requires payee/claimant to sign on Box D of the DV and the Check Registry/Logbook. Files temporarily Copies 2-3 of check, Copies 1-3 of DV, Copies 2-3 of ORS and SDs for preparation of reports. Posts in the 'Date Released' column of the ClcADADRec the date of release of the check to the claimant.

Preparation of Reports Daily

Cashier/ 27 Prepares Advice of Checks Issued and Cancelled (ACIC) Designated (Appendix 39) in accordance with existing rules and Staff regulations and forwards to the GSB.

28 Retrieves Copies 2-3 of checks, Copies 1-3 of DV, Copies 2-3 of ORS and SDs and prepares the RCI in four copies.

Note 8 — The RCI shall include all checks drawn during the day whether released or unreleased to the payees including cancelled ones.

Note 9 —For field offices without complete set of books of accounts, the Disbursing Officer submits the certified true copies of the CBReg together with the SDs to the Accounting Division/Units of their respective CO/RO/Division Office (DO) for recording in the books of accounts.

29 Initials in "Certification" portion of the RCI.

Cashier/Head 30 Reviews RCI and signs in "Certification" portion. of the Cash/ Treasury Unit

Designated 31 Distributes the RCI as follows: Staff

Original — COA Auditor, through the Accounting Division/Unit, together with the original copy of the paid DVs/payroll, copy of the check and SDs

Copy 2 — Accounting Division/Unit

Activity

70

Area of Seq. Responsibility No. Activity

Copy 3 - Budget Unit Copy 4 - Cash/Treasury Unit

Accounting Division/Unit

Receiving/ 32 Releasing Staff

Designated 33 Staff

34

Preparation of JEV

Daily

Receives Copies 1-2 of RCI with Copy 2 of the Check, Copies I and 3 of DVs, Copies 2-3 of ORS and other SDs from Cash/Treasury Unit. Forwards the documents to the Designated Staff for JEV preparation.

Examines DVs and checks against RU. Verifies if the serial number of all checks drawn whether released or unreleased, including spoiled and cancelled ones, are all accounted for.

portion. Forwards Copies 1-2 of JEV supported with Copies 1-2 of RU, Copy 2 of the Check, Copies 1 and 3 of DVs, Copies 2-3 of ORS and other SDs to the Chief Accountant/Head of Accounting Division/Unit.

Note 10 - For Regional Offices with field offices without complete set of books, the Designated Staff shall prepare the JEV based on the certified copy of CBReg submitted by the Disbursing Officer concerned. The said JEV shall be recorded in the ClcDJ.

Prepares JEV in two copies and signs in the "Prepared by"

Head of the 35 Reviews correctness of the journal entries and signs on Accounting "Certified Correct by" portion of the JEV. Forwards Division/Unit/ Copies 1-2 of JEV supported with Copies 1-2 of RU, Authorized Copy 2 of the Check, Copies 1 and 3 of DVs, Copies 2-3 Signatory of ORS and other SDs to Designated Staff for recording in

the ClcDJ.

Recording in the CkDJ Designated 36 Receives Copies 1-2 of JEV with Copies 1-2 of RU, Staff Copy 2 of the Check, Copies I and 3 of DVs, Copies 2-3

of ORS and other SDs. Records the JEV in the ClcDJ.

Note 11 - For Central Office with field offices without complete set of books, the JEV shall be recorded in the G.1.

Receiving/ 37 Records in the logbook submission of documents to COA Releasing Staff and Budget Division/Unit. Retains Copy 2 of JEV and

RC' and Copy 3 of ORS for file.

Note 12

To COA - Copy 1 of JEV, RCI, DV and NORSA (if there is any), Copy 2 of

71

-4

Area of I Seq. I Responsibility No. I Activity

checks, Copy 2 of ORS and SDs to the Receiving/ Releasing Staff

To — Copy 3 RCI with Copy 3 of DV for Budget posting of payments in Box C of Division/ ORS Unit

Note 13 — For the succeeding activities, refer to Chapter on Financial Reporting for the preparation and submission of Trial Balances, Financial Statements and Other Reports.

Sec. 13. Illustrative Accounting Entries for Disbursements By Check

Account Title Account Code Debit Credit I. Payment of the following utility bills:

Meralco Bill P 1,200 PLDT Bill 500 Maynilad Bill 200 Total Pa,90.0

Water Expenses 50204010 P 200 Electricity Expenses 50204020 1,200 Telephone Expenses 50205020 500

Cash-Modified Disbursement System (MDS), Regular 10104040 P 1,900

To recognize payment of bills from utility companies based on individual checks issued

2. Grant of cash advance for travel Advances to Officers and 19901040 P 1,000

Employees Cash-Modified Disbursement

System (MDS), Regular 10104040 P 1,000 To recognize granting of travel allowance to employees

Advance payment to Procurement Service Due from NGAs 10303010 P 2,500

Cash-Modified Disbursement System (MDS), Regular 10104040 P 2,500

To recognize advance payment to Procurement Service for the purchase of Office Equipment

Establishment of Petty Cash Fund (PCF) P 20,000

Petty Cash Fund 10101020 P 20,000 Cash-Modified Disbursement

System (MDS), Regular 10104040 To recognize establishment of PCF to cover petty expenses

P 20,000

72

Sec. 9. Procedures in Recording Appropriations and Allotments. The procedures for recording appropriations and allotments are as follows:

Area of Responsibility

Seq. No.

Activity

Staff Concerned

Budget Staff

Receives the GAA and the allotment release documents from the DBM. Records the same in the logbook and forwards these documents to the Budget Staff for recording in the RAPAL and RAOD.

2 Records the appropriations and allotments in the appropriate columns of the RAPAL and the RAOD. Forwards a copy of the allotment release documents to the Accounting Division/Unit for reference.

Note — The amount of allotment should not exceed the authorized appropriations in the GAA. If the allotment exceeds the appropriation, appropriate actions should be taken.

Sec. 10. Registries of Allotments, Obligations and Disbursements. The Registries of Allotments, Obligations and Disbursements (RAOD) shall be maintained by the Budget Division/Unit of agencies to record allotments, obligations and disbursements. It shall show the allotments received for the year, obligations incurred against the corresponding allotment and the actual disbursements made. The balance is extracted every time an entry is made to prevent incurrence of obligations in excess of allotment and overdraft in disbursements against obligations incurred. The RAODs shall be maintained by appropriation act, fund cluster, MFO/PAP, and allotment class.

Registry of Allotments, Obligations and Disbursements-Personnel Services (RAOD-PS) (Appendix 9A) shall be used to record the allotments received, obligations incurred and disbursements classified under PS.

Registry of Allotments, Obligations and Disbursements-Maintenance and Other Operating Expenses (RAOD-MOOE) (Appendix 98) shall be used to record the allotments received, obligations incurred and disbursements classified under MOOE.

Registry of Allotments, Obligations and Disbursements-Financial Expenses (RAOD-FE) (Appendix 9C) shall be used to record the allotments received, obligations incurred and disbursements classified under FE.

Registry of Allotments, Obligations and Disbursements-Capital Outlays (RAOD-CO) (Appendix 9D) shall be used to record the allotments received, obligations incurred and disbursements classified under CO.

Sec. 11. Obligation Request and Status. The incurrence of obligations shall be made through the issuance of Obligation Request and Status (ORS) (Appendix 11). The ORS shall be prepared by the Requesting/Originating Office supported by valid claim documents like DVs, payrolls, purchase/job orders, itinerary of travel, etc. The Head of the Requesting/Originating Office or his/her authorized representative shall certify in the Section A of the ORS as to the necessity and legality of charges to the budget under his/her supervision, and validity, propriety and legality of SDs. The Head of the Budget Division/Unit shall certify to the availability of allotment and such is duly obligated by signing in Section B of the ORS.

19

MFO/PAP

Particulars PAP Code

General Administration and Support 000001000000000

General Management and Supervision 103001000100000

Administration of Personnel Benefits 103001000200000

Support to Operations 000002000000000

a. Planning and Management Services 103002000100000

OPERATIONS 000003000000000

Operations

Law enforcement Services 000003010000000

*National Prosecution Services 146003010100000

*Witness Protection Security and Other Benefit 146003010200000

*Committee for the Special Protection for Children 146003010300001

*Implementaion of the Anti- Trafficking in Persons 146003010400000

*Office for Competition 146003010500000

*Office of Cybercrime 126003010600000

Corrections Services 000003020000000

*Pardon and Parole Services 144003020100000

*Victims Compensation Services-Board of Claims 146003020200000

Legal Services 000003030000000

*Legal 146003030100000

*Alternative Dispute Resolution Services 146003030200000

*Attendance to the Negotiation and Implementation of 146003030300000

Economic Agreements

Project

Implementation of Administrative Order No. 35 146004100300003

BuCor Transfer 144004100300006

National Justice Information System 146004100400001

Capacity Building Activities for Government Trade and 146004100500001

Investment Negotiations

croup Code Code Acronym 189-00 189-00 GC 189-00 189-00-00 GC 189-01 189-01 E0 189-01 189-01-01 OSEC 189-01 189-01-01-01 WPSBP 189-01 189-01-01-02 JUSIP J 189-01 189-01-02 USEC 189-01

189-02 189-02

189-02

189-02 189-02

189-02

189-02

189-02 189-02

189-02

189-02

189-02 189-02

189-02 189-02

189-02

189-02 189-02

189-02 189-02

189-03

189-03

189-03 189-04

189-04 189-05 189-05 189-05

189-05 189-05

189-06

189-06

189-06

189-06

189-06

189-07

189-01-03 ASEC 189-02 NPS 189-02-01 OCSP 189-02-01-01 BOC 189-02-01-02 SCPC 189-02-02 189-02-03

189-02-04

189-02-05

189-02-06 189-02-07

189-02-08

189-02-09 189-02-10

189-02-11 189-02-12

189-02-13

189-02-14

189-02-15 189-02-16 189-02-17 189-03

189-03-01 189-03-02

189-04 189-04-01 189-05

189-05-01 189-05-02

189-05-03 189-05-04

189-06

189-06-01

189-06-02

189-06-03

189-06-04 189-07

Witness Protection, Security and Benefits Program ustice System Infrastructure Projects

Office of the Undersecretary

Office of the Assistant Secretary National Prosecution Office

Office of the Chief State Prosecutor Board of Claims

Special Committee for the Protection of Children OACSP Office of the Assistant Chief State Prosecutor

NCR National Capital Region

RO1 Regional Office No. I

RO2 Regional Office No. II

RO3 Regional Office No. III

R04 Regional Office No. IV

RO5 Regional Office No. V

RO6 Regional Office No. VI

RO7 Regional Office No. VII

R08 Regional Office No. VIII

R09 Regional Office No. IX

R010 Regional Office No. X

R011 Regional Office No. XI

R012 Regional Office No. XII

R013 Regional Office No. XIII (CARAGA)

R014 Regional Office No. XIV (ARMM)

TECH Technical

TECH Technical Staff

CJJWC Comprehensive Juvenile Justice and Welfare Council

BPP Board of Pardon and Parole

OD-BP Office of the Director- BPP

LEG Legal Staff

OCSC Office of the Chief State Counsel

OACSC Office of the Assistant Chief State Counsel

IACAT Inter-Agency Council Against Trafficking

OADR Office of the Alternative Dispute Resolution

FMS Financial and Management Services

ODF Office of the Director - FMS

BUD Budget

ACCTG Accounting

MAD Management & Audit

ADM Administrative Service

Description General

General Classification Executice Office

Office of the Secretary

•- Denprtment of Justice

List of Respotisibility Centers

189-07 189-07-01 OD-AS Office of the Director - AS 189-07 189-07-02 GS General Service Division 189-07 ' 189-07-03 PERS Personnel Division 189-07 ' 189-07-04 INFO Information Division 189-07 189-07-05 CON Contractual Statistician 189-07 189-07-06 CAS Casual 189-08 189-08 PMS Planning and Management Service 189-08 189-08-01 ODM Office of the Director - MS0 189-08 189-08-02 PS Planning & Statistics 189-08 189-08-03 MIS Management Information Systems 189-08 189-08-04 MD Management Division 189-09 189-09 AUX Auxilliary 189-09 189-09-01 IA Internal Audit Group 189-09 189-09-02 OA-COA Office of the Auditor (COA) 189-10 189-10 OADR Office for Alternative Disputes Resolution 189-11 189-11 OFC Office for the Competition 189-12 189-12 IAS Internal Audit Service 189-13 189-13 00C Office of Cybercrime

Appendix 32

Fund Cluster:

Entity Name

DISBURSEMENT VOUCHER Date :

DV No.:

Nlodc of Payment

MDS Check UCoinmercial Check ADA Others (Please pecify)

Payee TIN/Employee No.: ORS/BURS No.:

Address

Particulars Responsibility

Center MFO/PAP Amount

Amount Due

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

Printed Name, Designation and Signature of Supervisor

Accounting Entry:

Account Title UACS Code Debit Credit

Certified: Approved for Paymeni

ID.

Cash available

Subject to Authority to Debit Account (when applicable)

Supporting documents complete and amount claimed proper

Signature Signature

Printed Name

Printed Name

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

Date Date

E. Receipt of Payment JEV No.

Check/

ADA No.:

Date : Bank Name & Account Number:

Signature : Date: Printed Name: Date

Official Receipt No. & Date/Other Documents

92

Appendix 11

OBLIGATION REQUEST AND STATUS Serial No

Date •

Fund ChISICI Entity Name

Payee

Office

Address

Responsibility Center Particulars MFO/PAP UACS Object

Code Amount

Total

A. B. Certified: Charges to appropriation/alloment are

necessary, lawful and under my direct supervision:and

supporting documents valid, proper and legal

:

Certified: Allotment available and obligated

he purpose/adjustment necessary as

above indicated

Signature

Printed Name:

Position

Date

for

Signature :

Printed Name:

Position

Date

Head, Requesting Office/Authorized Representative

Head, Budget Division/Unit/Authorized Representative

C. I STATUS OF OBLIGATION Reference Amount

Date Particulars ORS/JEV/Cheek: ADA/TRA No

Obligation Payable Payment

Balance

Not Yet Due Due and

Demandable

(a) (13) (c) (a-b) (DC)

42