Barangay Disbursement Voucher

DISBURSEMENT VOUCHER

DV No.:

Date:

Fund:

Payee Information

Payee (Name of Person / Entity)

Address

TIN / ID No.

Bank Account No. (if applicable)

Particulars / Nature of Payment

A. Certified:

Expenses/Cash Advance necessary, lawful and incurred under my direct supervision; supporting documents complete and proper.

Head of Office / Requesting Official

B. Approved for Payment:

Certified Correct

Barangay Treasurer

Approved by

Punong Barangay

Certified Available Funds

Barangay Treasurer

Supporting Documents Attached

Document Type

Document No. / Reference

Document Type

Document No. / Reference

Remarks / Other Documents

C. Receipt by Payee

Received from:

Amount of ₱:

In Words:

Check / Voucher No.

Date

Tax Withheld (if any)

Net Amount Received

Payee