Form A4 (2016 Edition)

DISBURSEMENT VOU
REF
DATE March 30, 2
TO: XU Finance Office
Please pay Adrian Christian B. Gamboa ACES
the sum of Twenty thousand pesos Php Php 20,00

as reimbursement refund (attach summary and receipts) / cash

payment for goods/services (attach supporting documents check
payroll item/honoraria (cut-off is every 10th and 25th of the month) payroll credit
/ advance for liquidation on (make 4 copies) fund transfer
others

DETAILS AMOUNT CHARGE ACC

Sample Entry: 51019099

ACES Year-End Evaluation 2017 Php 20000 ACES

(Please see attached proposal for details.)

Less: Tax % Php 0.00

TOTAL Php 20,000.00
Checked against Budget/Funding:
Requested by: Adrian Christian Gamboa
Project Head Marilyn M Castaares Angelico P Vall
Budget Controller Accounting- Special
Endorsed by: MS RICHEL P PETALCURIN Comment:
SACDEV Head

Approved: MR IVANELL R SUBRABAS Approved for Payment:

Director of Student Affairs
Ma Gina C Guioguio
Director, Budget & Asset Mgt
ACKNOWLEDGEMENT RECEIPT
Received from Xavier University Php

Adrian Christian Gamboa

Project Head

FOR ADVANCES:
Should we fail to liquidate the above amount advanced to us on or before
We hereby authorize XU Finance to hold our succeeding cash advances.
JOAN RAAKIN PRINCESS GABRIELLE T. L
 Treasurer President
Posted on: Liquidation Received:
Form A4 (2016 Edition)
DISBURSEMENT VOUCHER

March 30, 2017

ACES
Php 20,000.00

check
payroll credit
fund transfer

CHARGE ACCOUNT

51019099
ACES

Angelico P Vallar
Accounting- Special Funds

Date

PRINCESS GABRIELLE T. LIBETARIO

President