Petty Cash Request

Note: Petty cash requests must not exceed IDR 2,000,000

Please complete this form in its entirety. Without this information you cannot be reimbursed through our petty cash
fund. Each petty cash request form must have an authorizing signature and a description of items purchased
written on it. Original receipts must also be attached.

Department Date
Amount Requested Account Number
Requested By
Description of Need

I certify that the items described below were for PT. Maluk Griya amphibian and PT Kini Village Resort business.
If this is a personal reimbursement, I further certify that payment of the amounts claimed herein has not and will not be
reimbursed to me from any other source and that I have paid the above expenses for which reimbursement is claimed.

Account Purpose
Description (what was purchased) Amount
(MGA or KVR)

TOTAL Rp -

Approved By Signature

Received By Signature

** ORIGINAL RECEIPTS REQUIRED **

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