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Free disbursement voucher & repayment receipt
The paperwork for the money itself — what left the lender, what came back, and who signed for each. It sets the approved principal against every deduction to reach the net sum handed over, allocates a repayment across principal, interest, fees and penalties, and leaves the serial number, the stamp and the signatures that make a record of cash worth keeping.
Four ways money moves
The reference block, the amount in words, the stamp and the internal sign-off run through all four. What changes is the direction the cash is travelling, what the figures have to add up to, and whether the sheet is meant to be cut in two.
Preview
Every ruled line, tick box and table cell is for the cashier to complete by hand. Nothing is filled in, and the serial number is deliberately blank — number the pad before you start using it, not as you go.
Payment Voucher and Receipt
Serial no. | Date | Branch or office | Loan account no. |
Name in full | ID or passport no. | Phone |
Who is being paid The borrowerThe group accountA supplier or dealerA third party under written mandate | Account name |
Supplier or dealer, if paid direct | Invoice or proforma no. |
Approval reference | Date approved | Amount approved | Approved by |
Loan agreement signed YesNoN/A | Security lodged and registered YesNoN/A |
Guarantee signed and witnessed YesNoN/A | Identity verified YesNoN/A |
| Item | Amount | Reference or note |
|---|---|---|
| Principal approved | ||
| Less: arrangement or origination fee | ||
| Less: credit life or loan insurance | ||
| Less: compulsory savings or deposit | ||
| Less: interest or instalment taken in advance | ||
| Less: other deductions | ||
| Total deductions | ||
| Net amount payable to the recipient |
Net amount payable, in words |
Method of payment CashBank transferMobile moneyChequeInternal transfer |
Bank or mobile money provider | Account or wallet no. | Transaction reference | Value date |
I acknowledge that I have received the net amount shown above, in the manner recorded on this voucher, and that every deduction listed has been explained to me. I confirm that the loan agreement binds me for the full principal approved and not merely for the net sum I have taken away today.
Official stamp | Thumbprint, if the signatory cannot sign |
| Role | Name | Signature | Date |
|---|---|---|---|
| Prepared by | |||
| Checked by | |||
| Approved by | |||
| Paid out by |
This document is the record of a payment. It is valid only where it carries the signatures required above together with the lender's stamp, and any alteration to a figure on it must be initialled by whoever made the alteration.
File reference | Ledger account | Batch no. |
Captured by | System reference | Reconciled on |
Payment Voucher and Receipt
Serial no. | Date | Branch or office | Loan account no. |
Name in full | ID or passport no. | Phone |
Who is paying The borrowerA guarantorThe group treasurerA third party | Borrower, if not the payer |
Amount in figures | Amount in words |
Method of payment CashBank transferMobile moneyChequeInternal transfer |
Transaction reference | Value date | Instalment or period paid |
| Applied to | Amount |
|---|---|
| Principal | |
| Interest | |
| Fees and charges | |
| Penalties and late charges | |
| Insurance premium | |
| Savings or deposit contribution | |
| Total received |
Balance before | Balance after | Arrears remaining | Next instalment due |
Received with thanks, the amount shown above, applied to the loan account as set out on this receipt. This receipt is valid only when signed and stamped by the lender. Any balance shown is the balance at the date of this receipt and may change with interest, charges or later transactions.
Official stamp | Thumbprint, if the signatory cannot sign |
| Role | Name | Signature | Date |
|---|---|---|---|
| Received by | |||
| Posted to the ledger by |
This document is the record of a payment. It is valid only where it carries the signatures required above together with the lender's stamp, and any alteration to a figure on it must be initialled by whoever made the alteration.
Serial no. | Date | Loan account no. | Amount in figures |
Name in full | Received by | File reference |
Payment Voucher and Receipt
Serial no. | Date | Branch or office | Loan account no. |
Name in full | ID or passport no. | Phone |
Address | Loan product |
| Item | Amount |
|---|---|
| Original principal advanced | |
| Interest charged to date | |
| Fees, charges and penalties | |
| Total charged to the account | |
| Less: total paid before this payment | |
| Less: early settlement rebate allowed | |
| Final settlement amount received |
Amount in figures | Amount in words |
Method of payment CashBank transferMobile moneyChequeInternal transfer |
Bank or mobile money provider | Account or wallet no. | Transaction reference | Value date |
On receipt of the final settlement amount recorded above, and with effect from the date of that payment:
| (a) | the loan account named in this document is settled in full and closed, and no further instalment, interest, fee or penalty is payable under it; |
| (b) | every security, pledge, cession and lien the lender holds in respect of that account is released, and the lender will do whatever is reasonably required to have it removed from any register in which it is recorded; |
| (c) | every guarantee and suretyship given in respect of that account is discharged, and each guarantor and pledgor is released from all liability under it; |
| (d) | all title deeds, registration papers and other documents deposited as security are returned to whoever deposited them, against signature in the schedule below; |
| (e) | this certificate may be produced as proof of settlement to any credit bureau, registry or other third party. |
Complete this part for every item of security the lender holds against the account. Where the lender holds none, write "none" rather than leaving the space empty: an unfilled schedule cannot be told apart from an unfinished one, and it is the borrower who carries that afterwards.
Security released | Security register reference |
Date released | Released to | Title documents returned YesNoN/A |
| No. | Guarantor or pledgor released | ID or registration no. | Capacity | Signature |
|---|---|---|---|---|
| 1 | ||||
| 2 | ||||
| 3 |
The lender certifies that the loan account named above is paid in full and closed, that no further principal, interest, fee or penalty is owing under it, and that the lender abandons every claim arising from it other than a claim for a sum obtained by fraud or misrepresentation.
Official stamp | Thumbprint, if the signatory cannot sign |
| Role | Name | Signature | Date |
|---|---|---|---|
| Prepared by | |||
| Checked by | |||
| Approved by |
This document is the record of a payment. It is valid only where it carries the signatures required above together with the lender's stamp, and any alteration to a figure on it must be initialled by whoever made the alteration.
File reference | Ledger account | Batch no. |
Captured by | System reference | Reconciled on |
Payment Voucher and Receipt
Serial no. | Date | Branch or office | Group account no. |
Group name | Meeting date |
Chairperson | Treasurer | Members present | Members absent |
| No. | Member name | Loan account no. | Instalment due | Amount paid | Savings | Member signature |
|---|---|---|---|---|---|---|
| 1 | ||||||
| 2 | ||||||
| 3 | ||||||
| 4 | ||||||
| 5 | ||||||
| 6 | ||||||
| 7 | ||||||
| 8 | ||||||
| 9 | ||||||
| 10 | ||||||
| 11 | ||||||
| 12 |
| Item | Amount |
|---|---|
| Instalments due at this meeting | |
| Loan instalments collected | |
| Shortfall against instalments due | |
| Savings collected | |
| Penalties and fines collected | |
| Total cash received at this meeting |
Total cash received, in words |
Method of payment CashBank transferMobile moneyChequeInternal transfer |
The treasurer and the loan officer named below confirm that the amount entered against each member above was counted in the presence of that member and that the entries agree with the total cash received. Each member's signature beside their own row is that member's receipt for the amount shown against it.
Official stamp | Thumbprint, if the signatory cannot sign |
| Role | Name | Signature | Date |
|---|---|---|---|
| Collected by | |||
| Verified by | |||
| Banked by |
This document is the record of a payment. It is valid only where it carries the signatures required above together with the lender's stamp, and any alteration to a figure on it must be initialled by whoever made the alteration.
Serial no. | Date | Group account no. | Amount in figures |
Group name | Members present | Collected by |
How to use these forms
- 1Number the pad before anyone uses itEach of these is an accounting record, and an accounting record with no serial number proves very little: a voucher can be written twice and a receipt can disappear without leaving a gap behind it. Print the set, number it in sequence, and account for spoiled sheets rather than binning them.
- 2Write the amount in words as well as in figuresThe words are the control on the figures, which is why both are on the page — where the two disagree, most jurisdictions and every auditor read the words. Fill the line in fully and strike out whatever is left of it, so nothing can be added to either after the fact.
- 3Never let one person hold the whole chainThe voucher asks for four separate signatures — prepared, checked, approved, paid — because paying money out is the transaction a lender is defrauded through, and the control is simply that whoever writes the voucher is not whoever hands over the cash. Four names or the block is decoration.
What the set covers
- A serial number, date, branch and loan account reference at the head of every document
- Particulars of whoever is being paid or is paying, including a third party paying on the borrower's behalf
- A pre-payment checklist — agreement signed, security lodged, guarantee witnessed, identity verified
- A deductions schedule taking the approved principal down to the net amount actually handed over
- The amount in words as well as in figures, on all four versions
- Tick boxes for cash, bank transfer, mobile money, cheque and internal transfer, with the transaction reference beside them
- Allocation of a repayment across principal, interest, fees, penalties, insurance and savings
- Balance before, balance after, arrears remaining and the date of the next instalment
- A lettered discharge closing the account and releasing every security and guarantee on settlement
- A numbered group roster with instalment due, amount paid, savings and a member signature column
- A detachable counterfoil on the two versions that cross a counter
- An internal sign-off grid, a panel for the official stamp and a for-office-use block
Where does the cash record live afterwards?
A drawer of numbered vouchers is a control only for as long as somebody is adding them up. Lendbox posts every disbursement and every repayment to the loan and to the ledger as it happens, splits a payment across principal, interest, fees and penalties by the rules you set rather than by hand, and puts the day's takings beside what was actually banked.
See loan accounting & ledgersQuestions lenders ask
- It is the internal document that authorises money to leave the lender and records that it did. It names the loan, the recipient and the approval it relies on, shows the approved principal reduced by every deduction to the net sum actually handed over, and carries the signatures of the people who prepared, checked, approved and paid it. It is what an auditor asks for when they ask how a particular loan was paid out.
- Because the borrower rarely receives the amount they were approved for. Arrangement fees, credit life premiums, compulsory savings and interest taken in advance all come off first, and a borrower who signed for one figure and received another has a complaint unless the difference is written down and explained. The acknowledgement above the signature says in terms that the agreement binds them for the full principal approved, not for the net sum they walked out with.
- At a minimum: a serial number, the date, who paid, which account it was applied to, the amount in words and in figures, and a signature. This one also allocates the payment across principal, interest, fees, penalties, insurance and savings and shows the balance before and after — because "how much do I still owe" is the question every payer asks at the counter, and answering it on the receipt saves the phone call afterwards.
- A receipt exists in duplicate by definition: the payer needs proof of payment and the lender needs proof of what was received. The two versions that cross a counter carry a dashed line and a stub holding the serial number, date, account, amount and who took it, so the retained half is a complete record on its own. The two that stay in the file carry a for-office-use panel in its place.
- It says so in terms, in a lettered discharge covering the account itself, every security and pledge, every guarantee and suretyship, and the return of title documents against signature. Whether that is sufficient depends on where you are: security registered against a movable-assets register or a deeds office usually has to be cancelled there too, and the discharge undertakes that the lender will do what that requires. Treat it as the borrower's proof and as the instruction to your own staff, not as the deregistration itself.
- That is what the group collection version is for. Each member has a numbered row carrying their instalment due, what they paid, any savings taken and their own signature, and the totals underneath have to agree with the cash counted at the meeting. A member's signature beside their row is that member's receipt for the amount on it — which is why the column is there, and why the declaration records that the money was counted in front of them.
What is a disbursement voucher?
Why does the voucher show deductions rather than one amount?
What has to appear on a loan repayment receipt?
Why is there a tear-off counterfoil?
Does the settlement version actually release the security?
Can one sheet cover a whole group meeting?
This template is provided for general information and is not legal, accounting or tax advice. Cash-handling and receipting requirements vary widely: some jurisdictions prescribe the form of a receipt, the period for which vouchers must be retained, or the tax treatment of fees deducted at disbursement, and consumer-credit rules may govern what a borrower has to be told about deductions before the money is paid over. Have the set checked against your own regulator's requirements and your auditor's expectations before you print a pad of them.
Every payment on the loan, not in a drawer
Lendbox records each disbursement and each repayment against the loan and the ledger at the moment it happens, splits a payment across principal, interest, fees and penalties by your own rules, and shows the day's cash beside what was banked.
No card required