THE LEGIAN II - NIA ROAD COMPLEX CONSUMERS COOPERATIVE

REIMBURSEMENT/LIQUIDATION FORM
DATE SUBMITTED
PAYEE: VOUCHER NO. AMOUNT DATE RELEASED
PARTICULARS
51110 51160 73420 64160
DATE PAYEE PARTICULARS OR/INVREF. Amount PURCHASES FREIGHT-IN TRANSPO/TRAVEL TOLL FEES MISC

TOTAL
RUNNING TOTAL
INSTRUCTIONS: CASH ADVANCE
1. Fill-up the Date /Payee/Check No. &Amount /Particulars LESS: TOTAL EXPENSE
2. Fill-up Official Receipts details: OR date/Payee/Particulars/OR No./OR Amt FOR (REIMBURSE ) /RETURN
3 Prepared by: Checked by: Approved by: Noted by:

SIGNATURE OVER PRINTED NAME Bookkeeper General Manager Treasurer