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Appendix 44

LIQUIDATION REPORT Serial No.: _________________


Period Covered ________________ Date: _____________________

Responsibility Center Code:


Entity Name : _____________________________________________
Fund Cluster : _____________________________________________
__________________________

PARTICULARS AMOUNT

TOTAL AMOUNT SPENT


AMOUNT OF CASH ADVANCE PER DV NO.______DTD. ______
AMOUNT REFUNDED PER OR NO. ________DTD. ___________
AMOUNT TO BE REIMBURSED
A Certified: Correctness of the B Certified: Purpose of travel / C Certified: Supporting
above data cash advance duly accomplished documents complete and proper

________________________ ________________________ ________________________


Signature over Printed Name Signature over Printed Name Signature over Printed Name
Claimant Immediate Supervisor Head, Accounting Division Unit

JEV No.: ___________________

Date: ______________________ Date: _____________________ Date: _____________________

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