FEDERAL MEDICAL CENTRE, KATSINA

Statement of Expenditure In-Lieu of Receipt

NAME………………………………………………………… DATE ………………………

DEPARTMENT …………………………..........………………

S/n DESCRIPTION Rate Amount

Total

AMOUNT IN WORDS ……………………………………………………………………

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

Sign…………………………………. Rank………………………………...
 FEDERAL MEDICAL CENTRE, KATSINA
FINANCE & ACCOUNTS DEPARTMENT
PETTY CASH REQUEST FORM
DATE DESCRIPTION AMOUNT (NGN)

REQUEST BY: NAME……………………………………… SIGN…………… DATE………………

RECOMMENDATION: NAME……………………………… SIGN…………… DATE……………
AUTHORISATION: NAME……………………………………. SIGN……………. DATE…………..
ACKNOWLEDGEMENT: I, ……………………………………………….. hereby received the
above Amount from the Cash Officer for the said Assignment.
SIGNATURE …………………………………….. DATE: ………………………..