PAYMENT REQUISITION FORM
Building Scheme Number
*
DP/SP/CTS/OC number
Property Address
*
Unit Number or Lot Number
Date work was completed
*
/
Day
/
Month
Year
Date
Payment / Reimbursement to
*
Payee Postal Address
Payee Contact Number
*
Payee Email Address
*
example@example.com
Description for payment
*
$ Amount for Payment
*
BANK DETAILS
Account Name
*
BSB
*
Account Number
*
DECLARATION
DECLARATION
*
confirm that the above is true and correct
confirm that Committee Approval has been obtained for this payment request
Signed
*
Name
*
Date
*
/
Day
/
Month
Year
SUPPORTING DOCUMENTATION
Copies of tax invoices and supporting documentation MUST be attached.
Copies of tax invoices and supporting documentation attached
Committee approval attached
File/s Upload
*
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