Appendix 14 - BURS.xls - Google Sheets

	A	B	C	D	E	H	I	J	K	L	M
1										Appendix 14
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4	BUDGET UTILIZATION REQUEST AND STATUS								Serial No. : ___________________
5	_____________________________________								Date : _______________________
6	Entity Name								Fund Cluster :_________________
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8	Payee
9	Payee
10	Office
11	Office
12	Address
13	Address
14	Responsibility Center			Particulars			MFO/PAP		UACS Object Code/ Expenditures	Amount
15	Responsibility Center			Particulars			MFO/PAP		UACS Object Code/ Expenditures	Amount
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25				Total
26	A.						B.
27	A.	Certified:		Charges to appropriation/budget necessary,			B.	Certified: Budget available and utilized for
28		lawful and under my direct supervision; and supporting						the purpose/adjustment necessary as
29		documents valid, proper and legal						indicated above
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33	Signature :		____________________________________				Signature :		_________________________________
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35	Printed Name:		____________________________________				Printed Name:		_________________________________
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37	Position :		____________________________________				Position :		_________________________________
38			Head, Requesting Office/Authorized Representative						Head, Budget Division/Unit/Authorized Representative
39	Date :		_______________________________				Date :		____________________________
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42	C.	STATUS OF UTILIZATION
43	Reference					Amount
44	Date	Particulars			BURS/JEV/RCI/ RADAI/RTRAI No.	Utilization	Payable		Payment	Balance
45						Utilization	Payable		Payment	Not Yet Due	Due and Demandable
46						(a)	(b)		(c)	(a-b)	(b-c)
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