Fillable Missing Receipt Documentation - MISSING RECEIPT DOCUMENTATION_rev3

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Missing Receipt Documentation - MISSING RECEIPT DOCUMENTATION_rev3

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MISSING RECEIPT DOCUMENTATION
Check One:
Procurement Card Reimbursement Travel
Vendor Name: ________________________________________________________________________________________
Amount: _____________________________________________________________________________________________
Date Purchased: _______________________________________________________________________________________
Items Purchased:
Purpose of Purchase:
Please explain the circumstances resulting in the missing receipt:
Please explain the action taken to obtain a duplicate receipt from the vendor:
Please attach official documentation which certifies the transaction occurred (for example: credit card/debit card statement,
cancelled check, etc).
I certify and attest that the above statements are true and I have incurred the described expenses. I further certify that these
expenses were for official University purposes. I also have read and understand the University’s policy requiring original
receipts for reimbursement requests. This policy can be found at http://www.westga.edu/purchasing/index_2669.php
_________________________ __________________________________________ _________________________
Print Name Signature of Purchaser Date
_________________________ __________________________________________ _________________________
Print Name Supervisor/Department Head Signature Date
__________________________________________ ____________________________
Business & Finance Approval Date
Office of the Controller
Carrollton, Georgia 30118-4220
Division of Business and Finance
EXPLANATION OF THE PUROSE OF THE FORM
The use of this form does not replace the need for the individual to safeguard the original receipts or documentation required
for reimbursement of expense. The University of West Georgia recognizes that receipts can be lost or destroyed or in rare
cases, a physical receipt may not be possible. This form is used, in these circumstances, to document the specific information
regarding the expenditure and the disposition of the missing receipt.
This form should be completed by the individual with the information/knowledge to answer the questions; signed by the
individual and their department head. Final authority to utilize this form for payment/reimbursement purposes rests with the
appropriate department head in Business and Finance.
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Missing Receipt Documentation - MISSING RECEIPT DOCUMENTATION_rev3

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Completed 16 February 2020

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