Petty Cash Summary Form

Date:

Cheque Payable to: Employee ID

Department:

Project ID
Account Number (For Research) Description / Supplier Name Subtotal

Total: 0.00

(B) Total amount of GST / HST

(C) Total amount of Petty Cash fund
(D)Total amount of Cash on Hand
(E) Total Amount of Cheque (C - D)
(F) Total Cash Over or Short (A - E)

…………………………………………………………………………………………
Custodian Signature

……………………………………………………………………….Date:……………
Authorized Signature
*Expenses authorized by Department Chair (1), Director (2), Dean (3), Other
Authorized Signatory (4). Please follow preferred order.
 GST / HST Total

0.00 0.00 (A)

0.00

0.00
0.00

…………………………………………………

…………….Date:……………………………..

rector (2), Dean (3), Other

 Instructions for Preparation of Petty Cash Summary Form
1) Petty Cash Summary Form: Must be completed by the petty cash custodian to obtain reimbursement for expenditur
and to replenish the fund.

2) Complete Claim Form in Excel: Template is formula driven and should be completed in Excel.

3) Custodian and Authorizer: It is the responsibility of the Custodian and Authorizer to ensure the Petty Cash Summary
with required vouchers and receipts.
4)
Submitting a Request for Payment (Voucher): Requests for replenishment of petty cash fund must be submitted to
Services via Request a Payment at myUPEI. For instructions on how to Request a Payment at myUPEI, please refer to
Finance website.

5) Submitting your Petty Cash Summary Form: Summary form, vouchers, and receipts must be forwarded to Procurem
email to invoices@upei.ca. Please ensure you reference the myUPEI voucher number in the subject line of your em
6) Payment Services will begin to complete the payment process and issue a cheque to the custodian upon receipt of t
Summary Form and supporting documentation.
 n reimbursement for expenditures made from petty cash funds

d in Excel.

ensure the Petty Cash Summary Form is accurate and complete

cash fund must be submitted to Procurement and Payment

yment at myUPEI, please refer to Petty Cash Procedures on UPEI

must be forwarded to Procurement and Payment Services via

er in the subject line of your email (e.g. Voucher 1).

o the custodian upon receipt of the scanned Petty Cash


Date: 1-May-16
Cheque Payable to: John Smith
Department: Biology
Account Number
10-1-30-123456-987654
10-1-30-123456-987654
10-1-30-123456-987654
10-1-30-123456-987654
Petty Cash Summary Form
Project ID
(For Research) Description / Place of Purchase
Batteries, Superstore
Note Pad, Staples
Post it notes, Staples
Memory drive, Staples
Total:
(B) Total amount of GST / HST
(C) Total amount of Petty Cash fund
(D)Total amount of Cash on Hand
(E) Total Amount of Cheque (C - D)
(F) Total Cash Over or Short (A - E)
…………………………………………………………………………………………
Custodian Signature
……………………………………………………………………….Date:…………
Authorized Signature
*Expenses authorized by Department Chair (1), Director (2), Dean (3), Other
Authorized Signatory (4). Please follow preferred order.
ary Form

Subtotal GSTThe
/ HST
"Subtotal" Total
and
5.00 0.70
"GST/HST"
5.70
6.50 0.91
amount for 7.41
each item will
7.99 1.12
need to be 9.11
8.99 entered at
1.26 10.25
myUPEI,
Request a
Payment.
UPEI
Finance will
enter the
amount of
Cash Over or
Short for
you. For
instructions
for Request a
Payment at
myUPEI,
please refer to
Petty Cash
Procedures on
UPEI Finance
website.

28.48 3.99 32.47 (A)

3.99
nd 100.00
67.51
D) 32.49
E) (0.02)

……………………………………………………………………

……………………………….Date:……………………………..

Chair (1), Director (2), Dean (3), Other

ow preferred order.