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Appendix 11
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OBLIGATION REQUEST AND STATUSSerial No. : _____________________
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_____________________________________Date : _________________________
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Entity NameFund Cluster : ___________________
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Payee
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Office
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Address
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Responsibility CenterParticularsMFO/PAPUACS Object CodeAmount
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 Total
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A.Charges to appropriation/alloment areB.
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Certified:
Certified: Allotment available and obligated
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necessary, lawful and under my direct supervision;and
for the purpose/adjustment necessary as
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supporting documents valid, proper and legal
indicated above
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Signature : ___________________________________
Signature :
______________________________
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Printed Name: ____________________________________
Printed Name:
______________________________
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Position :____________________________________
Position :
______________________________
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Head, Requesting Office/Authorized RepresentativeHead, Budget Division/Unit/Authorized Representative
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Date :___________________________________
Date :
____________________________
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C.STATUS OF OBLIGATION
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ReferenceAmount
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DateParticularsORS/JEV/Check/ ADA/TRA No.ObligationPayablePaymentBalance
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Not Yet DueDue and Demandable
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(a)(b)(c)(a-b)(b-c)
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