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Obligation Request and Status Form

This document is an obligation request and status form. It requests funds for various payees and responsibilities. Section A certifies that the charges are necessary, lawful, and supervised. Section B certifies the availability and allotment of funds. Section C provides a status of obligations with reference numbers, amounts obligated and paid, and balances due. The second document is a report of checks issued by an agency. It lists check dates, numbers, disbursement voucher numbers, responsibility centers, payees, budget codes, and amounts for checks issued in a period. The certification confirms this is a full and accurate statement of checks issued with supporting disbursement vouchers.

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Rogie Apolo
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463 views2 pages

Obligation Request and Status Form

This document is an obligation request and status form. It requests funds for various payees and responsibilities. Section A certifies that the charges are necessary, lawful, and supervised. Section B certifies the availability and allotment of funds. Section C provides a status of obligations with reference numbers, amounts obligated and paid, and balances due. The second document is a report of checks issued by an agency. It lists check dates, numbers, disbursement voucher numbers, responsibility centers, payees, budget codes, and amounts for checks issued in a period. The certification confirms this is a full and accurate statement of checks issued with supporting disbursement vouchers.

Uploaded by

Rogie Apolo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
  • Obligation Request and Status
  • Report of Checks Issued

Appendix 11

OBLIGATION REQUEST AND STATUS Serial No. : _____________________

_____________________________________ Date : _________________________


Entity Name Fund Cluster : ___________________

Payee

Office

Address

UACS Object
Responsibility Center Particulars MFO/PAP Amount
Code

Total
A. Certified: Charges to appropriation/alloment are B. Certified: Allotment available and obligated
necessary, lawful and under my direct supervision;and for the purpose/adjustment necessary as
supporting documents valid, proper and legal indicated above

Signature : ___________________________________ Signature : ______________________________

Printed Name: ____________________________________ Printed Name: ______________________________

Position : ____________________________________ Position : ______________________________


Head, Requesting Head, Budget Division/Unit/Authorized
Office/Authorized Representative Representative
Date : ___________________________________ Date : ____________________________

C. STATUS OF OBLIGATION
Reference Amount
Balance
ORS/JEV/Check/ Obligation Payable Payment Due and
Date Particulars Not Yet Due
ADA/TRA No. Demandable
(a) (b) (c) (a-b) (b-c)

42
Proposed
REPORT OF CHECKS ISSUED
01/28
Period Covered: ________________
2014-01-028
Agency : JDG Department Report No.: ___________
Fund : 01 1234
Bank Name/Account No. _________________ 1
Sheet No.: _______________
Check DV No. / ORS/BUR Responsibility UACS Code/
Payee MFO/PAP/KRA Amount
Date No. Payroll No. Center Code Expenditure
1/28 023 2014-02-010 010 26-036-00-00000 ABC Corporation 3 01 01 0000 50604050 03 44,000 00
123

44,000 00

CERTIFICATION
I hereby certify that this Report of Checks Issued (RCI) in _________ sheet(s) is a full,
true and correct statement of all checks issued by me in payment for obligations for the period stated and
shown in the attached disbursement vouchers.
AO 6/15/02

Juan dela Cruz 01/29/14


Disbursing Date
Officer

42 Appendix 11 OBLIGATION REQUEST AND STATUS Serial No. : _____________________ _____________________________________ Date :
Proposed REPORT OF CHECKS ISSUED Period Covered: ________________ Agency : JDG Department Fund : 01 Bank Name/Acco

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