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Appendix 50
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PETTY CASH FUND RECORD
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Entity Name : _________________________
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Fund Cluster: _________________________
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_____________________________________________________________________________________________________
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Petty Cash Fund CustodianOfficial DesignationStation
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DateReference/
Check/ PCV No.
PayeeNature of PaymentCash Advance/ Replenishments
Received
Disbursements
Cash Advance
Balance
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C E R T I F I C A T I O N
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 I hereby certify that the foregoing is a correct and complete record of all cash advances received and disbursements made by me in my capacity as Petty Cash Fund Custodian of________________________ during the period from _________________ to _______________, inclusive, as indicated in the corresponding columns.
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___________________________________
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Name and Signature of Petty Cash Fund Custodian
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________________
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 Date
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