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BLGF form for petty cash voucher
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: No. : __________________
PETTY CASH VOUCHER
Entity Name :
Fund Cluster:
BUREAU OF LOCAL GOVERNMENT FINANCE Date : _________________
Payee/Office : ____________________________
Address : ________________________________
I. To be filled out upon request
Particulars
Responsibility Center Code:
______________________
II. To be filled out upon liquidation
Amount
Total Amount Granted
Total Amount Paid per
OR/Invoice No. _______
______________
______________
Amount Refunded/
(Reimbursed)
A
Requested by:
C
__________________________
Signature over Printed Name
Name of Requestor
Received Refund
Reimbursement Paid
Approved by:
__________________________
Signature over Printed Name
Name of Immediate Supervisor
B
Paid by:
__________________________
Signature over Printed Name
Petty Cash Custodian
__________________________
Signature over Printed Name
Petty Cash Custodian
D
Liquidation Submitted
Reimbursement Received by:
Cash Received by:
__________________________
Signature over Printed Name
Payee
Date: _______________
__________________________
Signature over Printed Name
Payee
Date: _______________
