PAYMENT APPROVAL FORM

THE LEGIAN II – NIA ROAD COMPLEX CONSUMERS COOPERATIVE

Money should not be disbursed until the Corporate Treasurer and Chairman have signed this form.
Block 2 Lots 5&7, Legian Imus II Subd. NIA Road Complex, Carsadang Bago I They should not sign this form until the upper section is filled out completely. If funds are advanced,
Imus City, Cavite CDA Reg No. 9520-1040000000037981 he or she signs the form, acknowledging receipt of the money, and also signs to show excess cash
were returned. Attach to this form; receipts, invoices, project proposal approval and Board Resolution.
Position of Requestor Date of Request Amount of Payment Requested

Name of Requestor of person to be paid Payment Category [ ] Cash Advance [ ] Reimbursement

[] Budget [] Other : __________________________

Payment purpose – detailed description
[] Supplies [] Infrastructure [] Bills Payment

[] Member’s Welfare Fund

Recipient : ____________________________________

Signature of Requestor Over Printed Name Attested by: Approved by:

JEREN VELASCO __________________________

______________________________________ Treasurer General Manager / Chairperson

Only fill out the rest of this form for a Cash Advance Liquidation

Signature of person receiving cash advance Date

Amount of cash received

Accounting for cash advance – to be filled out when person returns receipts and excess cash
Signature of person returning excess cash Date
Amount spent (must provide receipts) -

Disbursing Officer – excess cash was returned to me Date

Excess cash returned =

This portion is for Disbursement use only:

Reference Number corresponds to the petty cash batch or withdrawal date to - -
facilitate reconciliation Seq#
is to be use when there are multiple Y Y Y Y M M D D Amount Sequence

activities in one cash withdrawal

PAYMENT APPROVAL FORM

THE LEGIAN II – NIA ROAD COMPLEX CONSUMERS COOPERATIVE
Money should not be disbursed until the Corporate Treasurer and Chairman have signed this form.
Block 2 Lots 5&7, Legian Imus II Subd. NIA Road Complex, Carsadang Bago I They should not sign this form until the upper section is filled out completely. If funds are advanced,
Imus City, Cavite CDA Reg No. 9520-1040000000037981 he or she signs the form, acknowledging receipt of the money, and also signs to show excess cash
were returned. Attach to this form; receipts, invoices, project proposal approval and Board Resolution.
Position of Requestor Date of Request Amount of Payment Requested

Name of Requestor of person to be paid Payment Category [ ] Cash Advance [ ] Reimbursement

[] Budget [] Other : __________________________

Payment purpose – detailed description
[] Supplies [] Infrastructure [] Bills Payment

[] Member’s Welfare Fund

Recipient : ____________________________________

Signature of Requestor Over Printed Name Attested by: Approved by:

JEREN VELASCO __________________________

______________________________________ Treasurer General Manager / Chairperson

Only fill out the rest of this form for a Cash Advance Liquidation

Signature of person receiving cash advance Date

Amount of cash received

Accounting for cash advance – to be filled out when person returns receipts and excess cash
Signature of person returning excess cash Date
Amount spent (must provide receipts) -

Disbursing Officer – excess cash was returned to me Date

Excess cash returned =

This portion is for Disbursement use only:

Reference Number corresponds to the petty cash batch or withdrawal date to - -
facilitate reconciliation Seq#
is to be use when there are multiple Y Y Y Y M M D D Amount Sequence

activities in one cash withdrawal