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Annex “A”

Province of Isabela
Municipality of Sto. Tomas
Barangay Cañ ogan Abajo Sur

SK CHAIRPERSON CERTIFICATION (SKCC)

SKCC No. : _____________________


Date: _________________________
To: The Bank Manager
Land Bank of the Philippines
Cabagan Branch
Cabagan, Isabela

Sir/Madam:

This is to certify that the following checks were duly issued by Barangay Cañogan Abajo Sur
(Ito ay pagpapatunay na ang mga cheke na nakalista sa ibaba ay na-isyu ng Barangay Cañogan Abajo Sur,

Sto. Tomas, Isabela complete with respective Disbursement Vouchers and supporting
documents.
Sto. Tomas, Isabela na kumpleto ng kanya-kanyang Disbursement Vouchers at kalakip na mga dokumento.)

Account No. Check No. Date Payee Amount Purpose


4172103346

The undersigned attests to the truthfulness of the foregoing facts, under pain of
liability
(Pinapatotohanan ng may lagda ang mga nakasaad sa itaa, batid ang pananagutan

For falsification, pursuant to Article 171 (4) of the Revised Penal Code.
sa kasong “Falsification,” sang-ayon sa Article 171 (4) ng Revised Penal Code.)

Very truly yours,

HON. JERICO A. MELCHOR


SK Chairman

Delivered by: Received by:

DOMARIE GUMARU _____________________________


SK Treasurer Bank Representative
Date: ______________________ Date : ______________________

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