Details
| Amount | [US Dollar] [Amount] | Nominee | [A. Name] |
|---|---|---|---|
| Date | [Date] | Reason | [Description] |
| Status | [Created] |
Details
| Amount | [US Dollar] [Amount] | Foreign Currency | [Foreign Currency] |
|---|---|---|---|
| Date | [Date] | Reason | [Description] |
| Nominee | [A. Name] | Status | [Created] |
Comments
| [Comments] |
Canceled Items
| Case | Component | Covers Period | Credit | Debit |
|---|---|---|---|---|
| [field-value] | [Ad-hoc payment] | [field-value] | [Amount] | [Amount] |