Petty Cash Claim Form

Form No.: FIN-PC04

Petty Cash CLAIM Form

Sub-Voucher No: ___________________

Posting Date in Cash Journal in GEMS AP SAP: ___________________

A. To be filled-up by Claimant

Claimants Name

Cost Center

Division

Detail of claim (Please use additional sheet if needed)

No.DateDetail ExpenditureReceipt No. / DateCharging Account / CodeAmount (RM)

TOTAL

B. To be filled-up by Claimants Budget Holder

Acknowledgement for Petty Cash Claim Charging

I have verified that the above expenditure(s) incurred is (are) in accordance to the Petty Cash policy. I therefore approve the above charging of RM_______________ being the petty cash claim made by the aforesaid claimant who is under my supervision.

Signature

: _________________________

Name

: _________________________

Designation: _________________________

Date

: _________________________

C. To be filled-up by Petty Cash Holder

Acknowledgement for Petty Cash Claim Disbursement

I have verified that the above expenditure(s) is (are) fully-supported and in accordance to the Petty Cash policy. I therefore approve the disbursement of RM_______________ being the petty cash claim made by the aforesaid claimant who is covered under the petty cash fund allocated under my responsibility.

Signature

: _________________________

Name

: _________________________

Designation: _________________________

Date

: _________________________

D. To be filled-up by Petty Cash Keeper

Acknowledgement for Petty Cash Claim Payment

I have verified that this petty cash claim has been approved by both the Budget Holder and Petty Cash Holder. I therefore undertake that the approved claim of RM____________ is paid in full to the above Claimant.

Signature

: _________________________

Name

: _________________________

Designation: _________________________

Date

: _________________________

E. To be filled-up by Claimant

Acknowledgement for Receipt of Petty Cash Claim Payment

I hereby acknowledge that the approved claim payment of RM_______________ is received in full from the Petty Cash Keeper.

Signature

: _________________________

Name

: _________________________

Designation: _________________________

Date

: _________________________

FINANCE SSO Version : 1.1 Issued: 16 Nov 2007