Payment Request

To: Finance Manager

Date: / /2021

Payment type & details: Cash: Cheque: Transfer: IOU:

The Beneficiary: (………………………………………………………………………………………………………….)

Balance to Pay: : Currency

In Words: ……………………………………….………………………………………………………………………………………………………..

………………………………………………………………………………………………………………………………………………………………….

Description:

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Thanking you

Cost Center Requested by: …………………………………. Approved by: ………………..…………

Signature: …………………………………………. Signature: ……………………………….

For Accountant only:

SI No.
Received (Cash/ Cheque/ Docs. On ………………………………………………………

Name: ………………………………… Signature: ………………………………………….

Notes:

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Name: ………………………………. Name: …………………………………

Signature: ……………………………. Signature: …………………….………...