Petty Cash Voucher

- usually a small form that is used to document a disbursement (payment) from a petty cash fund.
- also referred to as petty cash receipts and can be purchased from office supply stores.

Appendix 48

No. : PCV 2018-04-001

PETTY CASH VOUCHER
Entity Name : GNVHS Date : 04/17/2018
Fund Cluster: 101101

Payee/Office :Saint Rose Photocopy Responsibility Center Code:

Address : Poblacion , Guiguinto, Bulacan ______________________

I. To be filled out upon request II. To be filled out upon liquidation

Particulars Amount
Total Amount Granted PHP 150.00
Payment for photocopy PHP 150.00
of documents for seminar Total Amount Paid per
and training. OR/Invoice No. 0110 PHP 150.00

Amount Refunded/
(Reimbursed) 0

A Requested by: C
Received Refund
TERESITA C. RIVERA
Signature over Printed Name / Reimbursement Paid
Name of Requestor

Approved by:

ROMAN M. CARREON MARA BELLE C. CADA

Signature over Printed Name Signature over Printed Name
Name of Immediate Supervisor Petty Cash Custodian

B Paid by: D
/ Liquidation Submitted
MARA BELLE C. CADA
Signature over Printed Name Reimbursement Received by:
Petty Cash Custodian
Cash Received by:

TERESITA C. RIVERA TERESITA C. RIVERA

Signature over Printed Name Signature over Printed Name
Payee Payee
Date: 4/17/2018 Date: 4/17/2018

127
 Appendix 48

No. : PCV 2019-01-001

PETTY CASH VOUCHER
Entity Name : GNVHS Date : 04/17/2018
Fund Cluster: 101101

Payee/Office :Saint Rose Photocopy Responsibility Center Code:

Address : Poblacion , Guiguinto, Bulacan ______________________

I. To be filled out upon request II. To be filled out upon liquidation

Particulars Amount
Total Amount Granted PHP 150.00
Payment for photocopy PHP 150.00
of documents for seminar Total Amount Paid per
and training. OR/Invoice No. 0110 PHP 150.00

Amount Refunded/
(Reimbursed) 0

A Requested by: C
Received Refund
TERESITA C. RIVERA
Signature over Printed Name / Reimbursement Paid
Name of Requestor

Approved by:

ROMAN M. CARREON MARA BELLE C. CADA

Signature over Printed Name Signature over Printed Name
Name of School Head Petty Cash Custodian

B Paid by: D
/ Liquidation Submitted
MARA BELLE C. CADA
Signature over Printed Name Reimbursement Received by:
Petty Cash Custodian
Cash Received by:

TERESITA C. RIVERA TERESITA C. RIVERA

Signature over Printed Name Signature over Printed Name
Payee Payee
Date: 4/17/2018 Date: 4/17/2018

127