PAYMENT REQUEST VOUCHER

Organization:

Voucher No:

Date:

PAYMENT REQUEST

Payee:

Amount:

Purpose of Payment:

Budget Line/Account:

Project/Event:

Supporting Documents Attached:

Field 16

Invoice Receipt Contract/Agreement Approval Email Other:

REQUESTED BY

Name:

Position:

Signature:

Date:

VERIFIED BY

Name:

Position:

Signature:

Date:

APPROVED FOR PAYMENT

Name:

Position:

Signature:

Date:

PAYMENT DETAILS

Payment Method:

Field 28

Online Transfer Cheque Cash Other:

Cheque/Transaction No.:

Date Paid:

Processed By:

Signature:

TREASURY USE ONLY

PRV Number:

Expense Code:

Recorded By:

Date Recorded:

Remarks: