CCard Declaration Form (MISSING RECEIPTS)

Purpose: This form is to be used when a receipt or other original documentation pertaining to a commercial card transaction was lost, accidentally destroyed, or unobtainable.

The University of Victoria requires that original receipts are submitted with the appropriate commercial card expense report. In circumstances where the original receipt is unobtainable or lost, this declaration form must be completed and signed by the commercial cardholder and their one over one approver.

Note: Repeated submission of a declaration in lieu of collecting receipts will initiate an escalation process that could result in CCard account deactivation.

Declaration: I, ____________________________, hereby declare that the original document described as (Cardholder’s first name and last name)

_______________________________________________________________________________________ (Describe the missing receipt in detail and indicate amount, where applicable)

was lost, accidentally destroyed, or unobtainable. I further declare that I have not and will not use this receipt to claim reimbursement from any other source or to support any claim in the future.

Signed:

Form must be signed by the cardholder and approved by the cardholder’s one over one supervisor.

Cardholder’s name (print) One over one approver’s name (print)

Cardholer’s signature

Date

One over one approver’s signature

One over one approver’s V# or title

Retention: This form must be attached to the applicable CCard expense report and submitted to Accounting Services.

Rev. November 2017