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Obligation Request (ObR)

This document is an obligation request and status form containing details of a proposed payment obligation. It includes sections for certification of the request by an authorized official, certification of available allotment by a budget officer, and a status table to track the obligation amount, payments made, and remaining balance due. The request provides information on the payee, office, responsibility center, appropriation codes, and total amount requested of $0.

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Lester Cuanico
Copyright
© © All Rights Reserved
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Download as XLS, PDF, TXT or read online on Scribd
247 views

Obligation Request (ObR)

This document is an obligation request and status form containing details of a proposed payment obligation. It includes sections for certification of the request by an authorized official, certification of available allotment by a budget officer, and a status table to track the obligation amount, payments made, and remaining balance due. The request provides information on the payee, office, responsibility center, appropriation codes, and total amount requested of $0.

Uploaded by

Lester Cuanico
Copyright
© © All Rights Reserved
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
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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 (Php) 0.00

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:

Position : Position :

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)
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

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