Road Fuel Draw Down Schedule Department * Quantity Recieved * Date Recieved * Quantity Issued * Date Issued * Balance * Coupon Serial Number * I/we hereby request for Cash withdrawal of USD/ZWL $ * Vehicle Reg Number * Vehicle Type ( e.g Tipper ) * Issued To : (Name) * Issued To : (Name) First First Last Last Issued By: ( Name) * Issued By: ( Name) First First Last Last Authorized By: ( Name) * Authorized By: ( Name) First First Last Last Designantion * Verification and Authorized Signatures By signing this form, you confirm that you have been recommended by your Departmental Head of Department. Issued To: (Signature) * signature keyboard Clear Date * Issued By: (Signature) * signature keyboard Clear Date * Authorized By: ( Signature) * signature keyboard Clear Date * Submit If you are human, leave this field blank.