005 - Appendix 41 Report of Cash Disbursement v.06..xlsx

	B	C	D	E	F	G	H	I	J
1									GAM Appendix 41
2
3		Report of Cash Disbursements
4
5
6		Form No. RCD-FMD-FM005			Version No. 06			Effectivity Date: October 15, 2024
7
8	Entity Name: COMMISSION ON POPULATION AND DEVELOPMENT REGION X							Report No. : ______________________
9	Fund Cluster : 101101101							Sheet No. : _______________________
10
11	Date	DV/Payroll No.	ORS/BURS No.	Responsibility Center Code	Payee	UACS Object Code	Nature of Payment		Amount
12	Date	DV/Payroll No.	ORS/BURS No.	Responsibility Center Code	Payee	UACS Object Code	Nature of Payment		Amount
13
14
15
16
17
18
19
20
21
22	CERTIFICATION
23			I hereby certify on my official oath that this Report of Cash Disbursements in _________ sheet(s) is a full, true and correct statement of all cash disbursements during the period stated above actually made by me in payment for obligations shown in pertinent disbursement vouchers/payroll.
24
25
26
27
28
29			__________________________________________________
30			Name and Signature of Disbursing Officer/Cashier
31
32				______________________________		___________
33				Official Designation		Date
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100