PCV Forms

BLGF form for petty cash voucher

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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: _______________