No.

____________________
PETTY CASH VOUCHER Date ___________________
Barangay: ____________________________________ City/Municipality: ___________________________________
Payee: _______________________________________ Province: __________________________________________
I. To be filled upon request
Particulars Amount II. To be filled up upon liquidation
Total Amount Granted -
Total Amount Paid -
Amount Refund/(Reimbursed) -
A. Requested by: C.

___________________________________________ Received Refund

Name of Requestor Reimbursement Paid

Approved by:

___________________________________________ _______________________________________
Punong Barangay Barangay Treasurer

B. Paid by: D.

____________________________________________ Liquidation Submitted by:

Barangay Treasurer Reimbursement Received by:

Cash Received by:

Signature over printed name Signature over printed name

Date: ______________________________ Date: _______________________________