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FUEL VOUCHER N°: FUEL VOUCHER N°:

To be used only for the purchase of fuel when not paid on delivery. To be used only for the purchase of fuel when not paid on delivery.

For a For a
Fuel station name:  
vehicle
ID: Fuel station name:  
vehicle
ID:

   
For For
   
stock stock
AUTHORISATION AUTHORISATION
Type of fuel to be delivered: Type of fuel to be delivered:
       
    Diesel   Gasoline   Kerosene       Diesel   Gasoline   Kerosene  
       
To deliver in the vehicle To deliver in the vehicle
Other: Other:
tanks(s):                             tanks(s):                          
     

    Full tank(s)     Jerrycan(s) litres       Full tank(s)     Jerrycan(s)       litres  

           
Specified Drum(s) or Specified Drum(s) or
    quantity:
litres    
cistern(s)  
litres       quantity:
      litres    
cistern(s)
      litres  
                                                                                                       
Authorized by (name and Authorized by (name and
  signature):
Date:     signature):
Date:  
       
                                                                                                       
FUEL DELIVERED FUEL DELIVERED
       
  Quantity delivered in figures: litres Date of delivery:  
  Quantity delivered in figures: litres Date of delivery:  
  in letters litres     in letters litres  
       
  Received by (employee name and signature): Signature of the station manager and stamp:     Received by (employee name and signature): Signature of the station manager and stamp:  
       
                                                                                                       
When the fuel is for the vehicle, do not forget to fill the fuel logbook.
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When the fuel is for the vehicle, do not forget to fill the fuel logbook.