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Format of Reimbursement for Petty Cash

Birth Certificate Affidavit Format__________  BANK
___________  Branch, ___________

Petty Cash Expenses

Please reimburse me the following expenses incurred by me for official purposes:

Particulars                                 Amount

_________                              _________
Total    ________________

Rupees (In Words) ______________________.

Passed for payment

Asst Vice President                Received payment

Voucher No:____________________
Date of payment: __________
Initials of passing officer:______________________

Signature of the Recipient

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