Sample DV
Sample DV
Sample DV
Mode of
MDS Check / Commercial Check ADA Others (Please specify)
Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee MARIGOLD STORE
157-686-860-000
A.B. Fernandez Ave., Dagupan City, Pangasinan
Address
Responsibility
Particulars MFO/PAP Amount
Center
EVANGELINE P. NAZARENO
Principal I
B. Accounting Entry:
Account Title UACS Code Debit Credit
Semi-Expendable Office Equipment 5020321002 2,996.00
Office Supplies 5020301000 6,340.00
Due to BIR 2020101000 - 500.15
Advances to Operating Expense 1990101000 - 8,835.85
Signature Signature
Printed
RODELITO B. CUARESMA Printed Name EVANGELINE P. NAZARENO
Name
BOOKKEEPER Principal I
Position Position
Authorized Representative Agency Head/Authorized Representative
Date 1/24/2022 Date 1/24/2022
E. Receipt of Payment JEV No.
Check/ Date : 1/24/2022 Bank Name & Account Number:
ADA No. : 963642 LBP-ALAMINOS
Date : 1/24/2022 Printed Name: MARIGOLD STORE Date
Signature :
92