Check Request Form

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

Check Request Form

Date: {{request_date}}

Request Number: {{request_number}}

Requester Information

Employee Name: {{employee_name}}

Department: {{department}}

Employee ID: {{employee_id}}

Contact Number: {{employee_contact_number}}

Payee Information

Payee Name: {{payee_name}}

Payee Address: {{payee_address}}

Bank Name (if applicable): {{bank_name}}

Account Number (if applicable): {{account_number}}

Bank Branch/Swift Code (if applicable): {{swift_code}}

Payment Details

Amount Requested: {{currency}} {{amount}}

Amount in Words: {{amount_in_words}}

Purpose of Payment: {{purpose_of_payment}}

Supporting Documentation Attached (e.g., invoices, receipts): {{supporting_documentation}}

Account Coding

General Ledger Account: {{gl_account_number}}

Cost Centre/Department Code: {{cost_centre_code}}

Project Code (if applicable): {{project_code}}

Authorization

Requested By (Employee Signature): _________________________ Date: ______________

Approved By (Manager/Department Head Signature): _________________________ Date: ______________

Approved By (Finance Department Signature): _________________________ Date: ______________

For Finance Department Use Only

Check Number: {{check_number}}

Date Issued: {{date_issued}}

Processed By: {{processed_by}}

Notes: {{finance_notes}}

Signature Block

_________________________

{{company_authorised_signatory_name}}

{{company_authorised_signatory_title}}