-Form A4_Cash Advance Form_2014

Form A4 (2014 Edition)

DISBURSEMENT VOUCHER REF DATE

TO: XU Finance Office Please pay the sum of as

/

Christian Phillip Lozano Five Hundred Pesos Only

###########

SBMSC Php

500.00

reimbursement refund (attach summary and receipts)

cash

payment for goods/services (attach supporting documents

check

payroll item/honoraria (cut-off is every 10th and 25th of the month)

payroll credit

advance for liquidation on

(make 4 copies)

fund transfer

AMOUNT

CHARGE ACCOUNT

others

DETAILS BUK-Bazaar: Wave 2

Php

500

5101-9095 SBMSC

(Please see attached proposal for details.)

Less: Tax TOTAL

%

Requested by:

(Signature Over Printed Name) Project Head

Endorsed by: Approved:

Php Php

0.00 500.00 Checked against Budget/Funding:

MS RICHEL P PETALCURIN SACDEV Head MR IVANELL R SUBRABAS Director of Student Affairs

Marilyn M Castañares

Angelico P Vallar

Budget Controller

Accounting- Special Funds

Comment:

Approved for Payment: Ma Gina C Guioguio Director, Budget & Asset Mgt

Date

ACKNOWLEDGEMENT RECEIPT Received from Xavier University Php Christian Phillip Lozano Treasurer FOR ADVANCES: Should I fail to liquidate above amount advanced to me on or before I hereby authorize XU to charge the same to my account via salary deduction.

Posted on:

Christian Phillip Lozano

Deoanalin May L Castillo

Treasurer

President

Liquidation Received: