PAYMENT REQUISITION FORM

RAISED BY: SIGNATURE: DATE: dd / mm / yy

DEPT: SITE: MODE OF PYMT:

PAYABLE TO:
AMOUNT (#) AMOUNT IN WORDS:

FOR INSTALMENT PAYMENTS, PLEASE INDICATE

TOTAL AMT APRVD (#) AMT (WORDS):
PYMTS TO DATE (#) AMT (WORDS):

BAL DUE (#) AMT (WORDS):

PAYMENT DESCRIPTION:_______________________________________________________________
_____________________________________________________________________________________
AUTHORISED BY APPROVED BY
NAME: NAME:
SIGNATURE: DATE: dd / mm / yy SIGNATURE: DATE: dd / mm / yy
POSITION: POSITION:
NB: IOUs MUST BE RETIRED WITHIN 14 DAYS OF JOB COMPLETION OR AFTER EACH PHASE (FOR PROJECTS) IS COMPLETED AND ANY UNUSED MONEY MUST BE
RETURNED TO THE COMPANY IMMEDIATELY. SANCTIONS, INCLUDING SALARY WITHHOLDING WOULD BE APPLIED TO DEFAULTERS

PAYEE’S ACCOUNT DETAILS: NAME SIGNATURE

ACCT NUMBER: AUDIT
BANK NAME: FINANCE
ACCT NAME: EXEC MGT
NOTE: ATTACH ALL SUPPORTING DOCUMENTS TO THIS FORM: INVOICES, RECEIPTS, STATEMENTS ETC.

PAYMENT REQUISITION FORM

RAISED BY: SIGNATURE: DATE: dd / mm / yy

DEPT: SITE: MODE OF PYMT:

PAYABLE TO:
AMOUNT (#) AMOUNT IN WORDS:

FOR INSTALMENT PAYMENTS, PLEASE INDICATE

TOTAL AMT APRVD (#) AMT (WORDS):
PYMTS TO DATE (#) AMT (WORDS):

BAL DUE (#) AMT (WORDS):

PAYMENT DESCRIPTION:_______________________________________________________________
_____________________________________________________________________________________
AUTHORISED BY APPROVED BY
NAME: NAME:
SIGNATURE: DATE: dd / mm / yy SIGNATURE: DATE: dd / mm / yy
POSITION: POSITION:
NB: IOUs MUST BE RETIRED WITHIN 14 DAYS OF JOB COMPLETION OR AFTER EACH PHASE (FOR PROJECTS) IS COMPLETED AND ANY UNUSED MONEY MUST BE
RETURNED TO THE COMPANY IMMEDIATELY. SANCTIONS, INCLUDING SALARY WITHHOLDING WOULD BE APPLIED TO DEFAULTERS

PAYEE’S ACCOUNT DETAILS: NAME SIGNATURE

ACCT NUMBER: AUDIT
BANK NAME: FINANCE
ACCT NAME: EXEC MGT
NOTE: ATTACH ALL SUPPORTING DOCUMENTS TO THIS FORM: INVOICES, RECEIPTS, STATEMENTS ETC.