Annex 13



PETTY CASH VOUCHER No. : ___________
Date : __________
Barangay:_________________________
Payee : __________________________
City/Municipality:____________________
Province: _________________________
I. To be filled up upon request
Particulars



Amount



II. To be filled up upon liquidation
Total Amount Granted -
Total Amount Paid -
Amount Refunded/ (Reimbursed) -
A. Requested by :
____________________________

Name of Requestor

Approved by :
________________________
Punong Barangay
C:


[]__ Received Refund
[]__ Reimbursement Paid

__________________________
Barangay Treasurer
B. Paid by :
_________________________
Barangay Treasurer


Cash Received by :
___________________________________
Signature over Printed Name of Payee

Date:____________________
D.


[]__Liquidation Submitted by:
[]_. Reimbursement Received by:

___________________________________
Signature over Printed Name of Payee

Date:__________________


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