DISBURSEMENT VOUCHER
Barangay: City/Municipality: DV No. :
Payee: Province: Date :
Address: TIN : Fund:
Particulars Amount
A. Certified as to existence of B. Certified as to availability of C. Certified as to validity,
appropriation for obligation funds for the purpose, and propriety, and legality of claim and
completeness and propriety of approved for payment
supporting documents
_______________________ _________________________ _________________________
(Signature Over Printed Name) (Signature Over Printed Name) (Signature Over Printed Name)
Chairman, Committee on Appropriation Barangay Treasurer Punong Barangay
Date : ____________ Date : _____________ Date : ______________
D. Received Payment:
Check No.: ___________
___________________________ Bank Name: __________ Date: __________
Signature Over Printed Name OR No.: ______________
E. Accounting Entries
Account Account Code Debit Credit
Prepared By:
RONIE M. GESUREM _______________
Barangay Bookkeeper Date
Approved By:
MARIA ROQUESA J. SAVERON, CPA _______________
Municipal Accountant Date