UVic ID#:
(if known)
Mailing Address:
(No PO Box addresses if wire payment is required)
City: Prov:
P/Code: Country:
Fund (5) Org (5) Acct (4) Actv (6) Locn (6) Amount
Printed Name
Date (dd-mmm-yy)
Contact Name Phone
I am the account holder (or delegate) responsible for this account and authorize that payment complies
to UVic policies, is appropriate, legitimate and that funds are available in budget. (Note: Delegates
cannot exceed their assigned dollar threshold).
If payable to an individual, please select one:
Refund Research Subject Fee
Student - Scholarship, Bursary, Award or Prize
Other Specify:
Date Received in Accounts Payable
T-Form CodeT-Form Type
Expense Allocation
Payment Request Details
Payee's SIN#
SIN# Required for payments greater than $100
Details or Purpose of Payment:
Accounting Services Use Only
Payment Request Form
Pay to: (Last Name, First, Initials or Full Company Name)
*Click here for form instructions*
Responsibility for complete, accurate, compliant and properly authorized payment requests rests with account holders and preparers.
This form is to initiate payment for transactions without an invoice such as funding transfers, remittances, honorariums and unscheduled scholarships or bursaries.
Payee Information
Banner Inv #
Banner Doc #
Accounting Services Use Only
Account Holder's Signature (Delegate)
Who to contact about this payment request
Payment will be mailed to the payee address provided or direct deposited if default. If special handling
is required explain below:
Is currency conversion
required? If "yes" specify:
Currencies other than CAD/USD will be paid by wire, attach
International Payment Information Form
Do not use this form for reimbursements
*Adobe Reader version XI is required
for optimal use of this form
Revised Oct2016
Quick Hints on Payment Requests
itself can be coded and signed appropriately and submitted to Accounts Payable for processing.
Payment RequestAccount Codes: This list details some of the most commonly used account codes or range of codes for payment
requests. Please refer to the full FAST account listing on our website for a comprehensive list. Please choose an account code that best fits
Service Purchases
Student Awards, Scholarships, Bursaries, Prizes
General Services
Space rentals
Staff training (registration form)
Inter-library loans
Other s
ervices (T4A type usual)
Sundry services
Subject fees/research participant
Royalties (right of use) T5, NR4
7275, 7294, 7295
Scholarships, bursaries and awards
Prizes (i.e. student competitions)
Special categories
Licenses and fees
Grants/funding transfers
Refunds & remittances
From liability accounts (GST, PST, etc)
From asset accounts
Accounts receivable
From revenue accounts
Note: Service providers should be supplying invoices for their
services and expense costs. Expense claim forms and
payment requests should not be used for making payments
to service providers. Only UVic faculty, staff, students and
UVic sponsored guests would normally be reimbursed for
business and travel expenses on travel and expense
reimbursement forms.
Internal charges occur when one university department sells goods or services to another university department. The sale and payment
that a quotation, pro-forma invoice, prepayment invoice, a registration form, a contract or some other form of
documentation/communication exists that provides valuable information to support the request for a payment. In these cases,
attach what is available. Sometimes, no documentation exists; in these cases; a detailed reason for the payment needs to contain
sufficient information to validate the payment request.
Some research granting agencies require supporting documentation beyond UVic requirements. Please be aware of any specific
Authorization for requesting payment must be given by the account financial manager (Account Holder) or their delegate.
Delegates are only able to sign up to their assigned allowable maximum dollar threshold.
Depending on the amount, type and/or policy related to a payment, a higher authorization may also be required (AVP, VP,
Dean, etc). Refer to controlling policy for specifics.
Canada Revenue Agency requires the University to report on a tax slip all payments for services made to an individual in a calendar
year that sum to more than $500. We are required to ask for the SIN# of these people so CRA can relate these payments to the
CRA does not distinguish between honorariums and services for hire, they consider them the same and as such the reporting is
required to be tracked from the first dollar paid each calendar year and reported when the minimum reportable amount of $500 is
exceeded. While we understand it is not always preferable to ask a honoree for their SIN#, CRA puts the onus on UVic to conduct
due diligence in asking for the information and using it in accordance with the reporting requirements.
Revised Oct2016