Petty Cash Fund Approval Form printable pdf download

Attachment to FAM 1706 – Accounting for Petty Cash (Appendix ‘A’)

PETTY CASH FUND APPROVAL FORM

All applicable parts on all pages of this form must be completed and signed in order to establish,

amend or close a petty cash fund or to replace the custodian.

REQUEST FOR APPROVAL to (check applicable boxes):

 Establish a fund

 Amend a fund

 Close a fund

 Replace the custodian

Location:

.......................................................................................................................................................

Why necessary:

.......................................................................................................................................................

Proposed amount of fund:

$ .....................................

Justification:

.......................................................................................................................................................

.....................................................................................................................................................

Proposed maximum value of single transactions using the fund:

$ .....................................

Justification:

.......................................................................................................................................................

.....................................................................................................................................................

Proposed  temporary custodian or  permanent custodian (check one) to sign:

I certify by my signature that: I have read Financial Administration Manual Policy 1706 -

Accounting for Petty Cash and will adhere to its requirements; I will be personally responsible

for petty cash and all related documentation placed in my care; and, I understand that, at the

discretion of the Comptroller General, I may be required to repay to the Government any petty

cash lost due to my own negligence.

Name: .........................................................................................................

Position: ......................................................................................................

Signature: ...................................................... Date: ..................................

Petty Cash Fund Approval Form

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