ACKNOWLEDGEMENT RECEIPT
Received from ( ), ( ) of Department of Social
FULL NAME of DSWD Personnel Designation/Position
Welfare and Development Field Office V the amount of (__________) as payment for
Amount
(________________) on (__________)
Purchased Product/Service Date of Payment
Address of Payee: ___________________,__________________,__________________
Barangay City/Municipality Province
Contact number of Payee (if applicable):
Reason for Non-issuance of OR:
(if applicable)
Signature over
Printed Name of Payee
**The information required In this AR is in compliance with the minimum data content of receipt of payment evidences provided in No. 3.2
under III. General Guidelines and Principles of COA Circular No. 2004-006 dated Sep. 9, 2004.
ACKNOWLEDGEMENT RECEIPT
Received from ( ), ( ) of Department of Social
FULL NAME of DSWD Personnel Designation/Position
Welfare and Development Field Office V the amount of (__________) as payment for
Amount
(________________) on (__________)
Purchased Product/Service Date of Payment
Address of Payee: ___________________,__________________,__________________
Barangay City/Municipality Province
Contact number of Payee (if applicable):
Reason for Non-issuance of OR:
(if applicable)
Signature over
Printed Name of Payee
**The information required In this AR is in compliance with the minimum data content of receipt of payment evidences provided in No. 3.2
under III. General Guidelines and Principles of COA Circular No. 2004-006 dated Sep. 9, 2004.