___________ BANK
___________ Branch, ___________
Petty Cash Expenses
Please reimburse me the following expenses incurred by me for official purposes:
Particulars Amount
________________
Total ________________
Rupees…………………………………………………….
Passed for payment
Asst Vice President Received payment
Voucher No:…………………………
Date of payment: ……………………
Initials of passing officer:…………… Signature of the recipient