Check Request Form

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

Check Request Form

**Date:** {{request_date}}

**Requestor Name:** {{requestor_name}}

**Department:** {{department}}

**Vendor/Payee Name:** {{payee_name}}

**Payee Address:** {{payee_address}}

Payment Details

**Amount (in ZAR):** R{{amount_in_zar}}

**Amount (words):** {{amount_in_words}}

**Reason for Payment:** {{reason_for_payment}}

**Invoice/Reference Number (if applicable):** {{invoice_reference_number}}

**Due Date:** {{due_date}}

Account Coding

**General Ledger Account:** {{gl_account_number}} - {{gl_account_description}}

**Cost Centre/Project Code:** {{cost_centre_project_code}}

**Budget Line Item:** {{budget_line_item}}

Supporting Documentation

Please attach all relevant supporting documentation (e.g., invoices, purchase orders, receipts).

**Attached Documents:** {{list_of_attached_documents}}

Authorization

**Requested by:**

Name: {{requestor_print_name}}

Signature: __________________________

Date: {{requestor_signature_date}}

Departmental Approval

**Approved by (Department Head/Manager):**

Name: {{approver_print_name}}

Signature: __________________________

Date: {{approver_signature_date}}

Comments: {{approver_comments}}

Finance Department Use Only

**Check Number:** {{check_number}}

**Date Issued:** {{check_issue_date}}

**Posted to GL:** {{gl_posting_confirmation}}

**Processed by:** {{finance_processor_name}}

Signature: __________________________

Date: {{finance_processing_date}}

Signature Block

__________________________

{{authorized_signature_name}}

{{authorized_signature_title}}

Date: {{signature_date}}