__________  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