Adjustment/Correction Form Adjustment/Correction Form

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Form No: _________ Form No: _________

Branch Copy Main Office Copy


Adjustment/Correction Form Adjustment/Correction Form
for System-related errors for System-related errors
Requesting Office:___________________ Request Date: ____________ Requesting Office:__________________ Request Date: ______________

Type of Adjustment: Type of Adjustment:


____ Double-posting ____ Misposting ____ Double-posting ____ Misposting
____ Others: Please specify ____________________________________ ____ Others: Please specify ______________________________________

For Double-posting (not double-payment): For Double-posting:


Incident Date: _____________ Period Covered: _____________________ Incident Date: ____________ Period Covered: _____________________
CC#: _____________________ Account Name: ___________________ CC#: ____________________ Account Name: ______________________
OR#/Posting Ref: ___________ Amount: ________________________Php OR#/Posting Ref: __________ Amount: ________________________Php
Reason of double-posting: ______________________________________ Reason of double-posting: ________________________________________

For Misposting: For Misposting:


Incident Date: _____________ Period Covered: ____________________ Incident Date: ____________ Period Covered: _____________________
Posted to CC#: ____________ Account Name: ____________________ Posted to CC#: ___________ Account Name: ______________________
OR#/Posting Ref: ___________ Amount: ______________________Php OR#/Posting Ref: __________ Amount: ________________________Php
Should be to CC#: ______________ Name: _______________________ Should be to CC#: _______________ Name: __________________________
Reason why misposted: ____________________________________ Reason why misposted: __________________________________________

Other concerns: __________________________________________ Other concerns: _________________________________________________


Details/Notes: ______________________________________________ Details/Notes: __________________________________________________
_________________________________________________________ _______________________________________________________________

Requested by: __________________Noted by: __________________ Requested by: ____________________Noted by: _____________________

for Main Office for Main Office


Verified by: ______________________ Date: __________________ Verified by: ______________________ Date: ________________________
Notes: ___________________________________________________ Notes: _________________________________________________________
Approved by: _____________________ Date: _________________ Approved by: _____________________ Date: ________________________
Instructions: ________________________________________________ Instructions: ____________________________________________________
Posted/Corrected by: ___________________Date: ______________ Posted/Corrected by: ____________________Date: ___________________
Remarks: __________________________________________________ Remarks: _______________________________________________________
Noted by: ________________________ Date: ___________________ Noted by: _________________________ Date: ________________________
Remarks: __________________________________________________ Remarks: _______________________________________________________
No: _________
Office Copy

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________Php
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Form No: ______ Form No: ______
Branch Copy Main Copy
Adjustment/Correction Form Adjustment/Correction Form
for System-related errors for System-related errors
Requesting Office:___________________ Request Date: ___________ Requesting Office:__________________Request Date: ___________

Type of Adjustment: Type of Adjustment:


____ Double-posting ____ Misposting ____ Double-posting ____ Misposting
____ Others: Please specify __________________________________ ____ Others: Please specify __________________________________

For Double-posting (not double-payment): For Double-posting (not double-payment):


Incident Date: _____________ Period Covered: ___________________ Incident Date: ____________Period Covered: ___________________
CC#: _____________________ Account Name:___________________ CC#: ____________________Account Name:___________________
OR#/Posting Ref: ___________ Amount: ______________________Php OR#/Posting Ref: _________ Amount: ______________________Php
Reason of double-posting: __________________________________ Reason of double-posting: __________________________________

For Misposting: For Misposting:


Incident Date: _____________ Period Covered: _________________ Incident Date: ____________Period Covered: _________________
Posted to CC#: ____________ Account Name: _________________ Posted to CC#: ___________ Account Name: _________________
OR#/Posting Ref: ___________ Amount: ______________________Php OR#/Posting Ref: _________ Amount: ______________________Php
Should be to CC#: ______________ Name: _____________________ Should be to CC#: ______________ Name: _____________________
Reason why misposted: ____________________________________ Reason why misposted: ____________________________________

Other concerns: ________________________________________ Other concerns: ________________________________________


Details/Notes: ____________________________________________ Details/Notes: ____________________________________________
_______________________________________________________ _______________________________________________________

Requested by: _________________Noted by: _________________ Requested by: _________________Noted by: _________________

for Main Office for Main Office


Verified by: ______________________ Date: __________________ Verified by: ______________________ Date: __________________
Notes: ___________________________________________________ Notes: ___________________________________________________
Approved by: _____________________ Date: _________________ Approved by: _____________________ Date: _________________
Instructions: ______________________________________________ Instructions: ______________________________________________
Posted/Corrected by: __________________Date: ______________ Posted/Corrected by: __________________Date: ______________
Remarks: _________________________________________________ Remarks: _________________________________________________
Noted by: _______________________ Date: ___________________ Noted by: _______________________ Date: ___________________
Remarks: _________________________________________________ Remarks: _________________________________________________

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