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Date:
Cheque Payee:
Address to where cheque is
being forwarded to: (Please
provide a current address for
payee).
Contact No:
Faculty/ Portfolio:
Account and Department /
Project Code to be charged:
Details and purpose of Expenditure Amount ($)
I certify that the expenditure has been incurred on behalf of Federation University Australia Total $
Signature of Claimant: Claim Approved by Financial Delegate:
Name of Claimant: Name of Financial Delegate:
Financial Use only
Vendor Number: Finance Officer Check:
Account Department /
Project
$ Applicability VAT Code Transaction Type
Initials of Cheque Signer:
Email
CRICOS Provider No. 00103D Cheque Requisition Form
Page 1 of 1
Warning: uncontrolled when printed.
Authorised by: Associate Director, Financial Accounting and Systems Original Issue:
Document owner: Student Finance Current Version: 08/03/2014
$ 0.00