Department ___________________________
Custodian ____________________________ Fund Amount ________________________
As Custodian, I understand that I am responsible for the security and maintenance of this
petty cash fund according to the following procedures:
1. The petty cash fund will be locked in a secure place at all times.
2. All disbursements from the fund must have proper back-up and supporting vouchers
(i.e. invoices and receipts) and will be made in accordance with current University
Purchasing, and Travel and Entertainment Policies. Note that under these policies, most
purchases of goods or services over $50 must be done through the purchasing
3. At all times the total of the receipts plus the cash must equal the fund balance.
4. In order to replenish the fund, a “Petty Cash Custodian Replenishment Request Form” will be
submitted to Financial Services, complete with supporting receipts, account coding, and proper
5. The reimbursement will be in the form of a cheque payable to the “Custodian’s
Name-In Trust” and will be processed during the normal weekly cheque run. It is the responsibility
of the Custodian to allow time for this process.
6. The Custodian may not delegate responsibility for the fund.
7. If the petty cash fund is no longer required it will be returned to Financial Services promptly.
I agree to accept responsibility for the petty cash fund according to the above conditions.
Custodian _________________________
Date _____________________________
To be Completed when Petty Cash is returned:
Amount Returned : _________________________ Date ______________________
Received By: _________________________________
Revised September 20, 2001
Conference Office
Cindy Allan