APPLICATION TO REQUEST A NEW PETTY CASH OR CHANGE

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Application to Become a Petty Cash or Change Fund Custodian

Application to Request a new Petty Cash or Change Fund

This application is designed to assist General Accounting in assessing the need of the requesting department to establish a petty cash or change fund.

Questions 1, 2 and 3 are for Petty Cash requests only.

NOTE. Petty Cash funds will be authorized only when other purchasing and disbursements procedures, like ‘Express Card’ or ‘MarketPlace’, cannot meet the needs of the requesting department.


1.Has your department investigated purchasing and disbursements procedures, like ‘Express Card’ or ‘MarketPlace’, and considered alternatives besides a Petty Cash fund?
Please explain/document why ‘Express Card’ or ‘MarketPlace’ do not serve the needs of your department.




2. What are the unique business/procurement needs of the department that justify having cash on hand rather than using established purchasing and disbursements procedures?
Please provide detailed description of services/goods to be purchased.




3. What is your forecast in dollars of your Petty Cash monthly expenditures?



4. Who will be the custodian? Name, job title, department, mail code, email address, and phone number. Please include UCSD’s employee number




5. Who is the financial officer or MSO assuming ultimate responsibility for the cash fund? Name, job title, department, mail code, email address, and phone number.




6. What is the amount of the fund you are requesting? If you are requesting a change fund, please explain the need for the amount of your request. (note: funds requested should be kept to an absolute minimum)



7. Please give a description of the physical security measures and key internal controls in place to safeguard against cash loss or theft (e.g., safe, lockbox, etc.).



8. Please provide the index/fund source to be charged in the event of a theft or loss.



Please review PPM 300-10, PPM 300-11, the Accounting Manual C-173-61, and BUS-49. By signing this application, you agree to follow the policies and procedures outlined in the above referenced documents.

UAPPLICATION TO REQUEST A NEW PETTY CASH OR CHANGE CSD – Department



MSO or Financial Officer - Name/Signature Prospective Custodian - Name/Signature


APPLICATION TO REQUEST A NEW PETTY CASH OR CHANGE Date of Request

Email this application (.pdf) to [email protected], or fax to x48533, or mail to MC0953, attention: Petty Cash/Change Funds. Thank you.


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