ACKNOWLEDGEMENT RECEIPT ACKNOWLEDGEMENT RECEIPT
(INSTRUCTION) (INSTRUCTION)
General Instruction: This form shall ONLY be used by the SLP Program Participants to Purchase Goods/Services from General Instruction: This form shall ONLY be used by the SLP Program Participants to Purchase Goods/Services from
entities/individuals that are UNABLE TO ISSUE OFFICIAL RECEIPTS/INVOICE entities/individuals that are UNABLE TO ISSUE OFFICIAL RECEIPTS/INVOICE
The end-user of this form must ensure COMPLETENESS, ACCURACY, and TRUTHFULNESS of data The end-user of this form must ensure COMPLETENESS, ACCURACY, and TRUTHFULNESS of data
in accomplishing this document. DO NOT LEAVE ANY FIELD BLANK UNLESS NOT APPLICABLE in accomplishing this document. DO NOT LEAVE ANY FIELD BLANK UNLESS NOT APPLICABLE
Ang form na ito ay marapat lang gamitin ng mga SLP Program Participants upang bumili ng Ang form na ito ay marapat lang gamitin ng mga SLP Program Participants upang bumili ng
Produkto/Serbisyo mula sa entidád/indibidwal NA HINDI MAKAPAG-ISYU NG OPISYAL NA RESIBO Produkto/Serbisyo mula sa entidád/indibidwal NA HINDI MAKAPAG-ISYU NG OPISYAL NA RESIBO
Ang gagamit ng form na ito ay marapat siguruhin na KUMPLETO, TAMA , at MAKATOTOHANAN Ang gagamit ng form na ito ay marapat siguruhin na KUMPLETO, TAMA , at MAKATOTOHANAN
ang mga nakalagay na detalye sa dokumentong ito. HUWAG IWAN NA BLANGKO ANG MGA ang mga nakalagay na detalye sa dokumentong ito. HUWAG IWAN NA BLANGKO ANG MGA
PATLANG MALIBAN KUNG HINDI "APPLICABLE" PATLANG MALIBAN KUNG HINDI "APPLICABLE"
Entity Name: Name of the SLPA that performed the financial transaction (Indicate N/A for indvidual) Entity Name: Name of the SLPA that performed the financial transaction (Indicate N/A for indvidual)
Control Number: Control number created by the association to ensure uniqueness of each acknowledgment Control Number: Control number created by the association to ensure uniqueness of each acknowledgment
Date: Date shall reflect the actual date of the transaction following the standard format (mm/dd/yyyy) Date: Date shall reflect the actual date of the transaction following the standard format (mm/dd/yyyy)
RECEIVED from: This field must indicate the NAME of the PAYOR (SLPA Participant) who performed the financial RECEIVED from: This field must indicate the NAME of the PAYOR (SLPA Participant) who performed the financial
transaction transaction
Official Designation: This must reflect the official position/designation of the SLPA Officer/Member who acted as the Official Designation: This must reflect the official position/designation of the SLPA Officer/Member who acted as the
PAYOR (e.g President/Treasurer/Secretary etc) PAYOR (e.g President/Treasurer/Secretary etc)
the amount of (In Actual total amount of the purchase products/services WRITTEN IN WORDS the amount of (In Actual total amount of the purchase products/services WRITTEN IN WORDS
Words Words
the amount of (In Actual total amount of the purchase products/services WRITTEN IN NUMERICAL VALUE the amount of (In Actual total amount of the purchase products/services WRITTEN IN NUMERICAL VALUE
figures) figures)
in payment for: This field must indicate the purpose of the financial transaction (e.g Purchase of raw chicken in payment for: This field must indicate the purpose of the financial transaction (e.g Purchase of raw chicken
tenders, labor cost for construction etc) tenders, labor cost for construction etc)
PAYEE Name of company/corporation/association/ where the service/product was purchased from. It PAYEE Name of company/corporation/association/ where the service/product was purchased from. It
must include the NAME OF ENTITY of the payee AND FULL NAME of the person that the must include the NAME OF ENTITY of the payee AND FULL NAME of the person that the
SLPA/Program Participants transacted with, Full Address, Contact Number and affixed wet SLPA/Program Participants transacted with, Full Address, Contact Number and affixed wet
signature signature
WITNESS: This must include the name of a public official (Authorized Representative) from the B/MLGU WITNESS: This must include the name of a public official (Authorized Representative) from the B/MLGU
certifying the authenticity of the transaction, Official Designation, Address Contact Number and certifying the authenticity of the transaction, Official Designation, Address Contact Number and
wet signature wet signature
ACKNOWLEDGEMENT RECEIPT ACKNOWLEDGEMENT RECEIPT
Control No: Control No:
Control No: Control No:
Entity Name: Entity Name:
Date: Date:
RECEIVED from: RECEIVED from:
(Name) (Official Designation) (Name) (Official Designation)
the amount of the amount of
(In Words) (In Words)
(Php. ) in payment for (Php. ) in payment for
(In Figures) (In Figures)
PAYEE PAYEE
Entity Name/Full Name: Entity Name/Full Name:
Signature: Signature:
Address: Address:
Contact Number: Contact Number:
WITNESS (Required) WITNESS (Required)
(Authorized B/LGU/Public Official) (Authorized B/LGU/Public Official)
Full Name: Full Name:
Designation/Office Designation/Office
Signature: Signature:
Address: Address:
Contact Number: Contact Number:
