Research Corporation of the University of Hawaiʻi

Petty Cash Summary Sheet

Period Beginning: __________________________ Ending: __________________________

1. Petty Cash Advanced …………………………………………………………………….. $ _____________

2. Cash on Hand ……………………………………….. $ ___________________

3. Expenses (original receipts attached) ……….. $ ___________________

4. Cash Reimbursement in Transit ……………….. $ ___________________

TOTAL PETTY CASH (lines 2, 3 & 4) ……………………………………. $ _____________
Please attach itemized listing together with applicable original receipts.

Submitted by: ___________________________________________ Date _____________________
Custodian Signature

Approved by: ____________________________________________ Date _____________________
Principal Investigator Signature

Approved by: _____________________________________________ Date ____________________
Fiscal Officer Signature

MAKE CHECK PAYABLE TO: _____________________________________, Custodian, in the

amount of $ _________________________ (reference line 3).

Project Name: __________________________________________________________________

Address: __________________________________________________________________

__________________________________________________________________

PROJECT TO BE CHARGED:

Project Number Budget Category Amount

____________ _______ _________________

____________ _______ _________________

____________ _______ _________________

____________ _______ _________________

____________ _______ _________________

TOTAL: _________________

PETTY CASH SUMMARY SHEET
Instructions

A petty cash fund is a fixed sum of money for the purpose of making cash payments for small purchases where more formal procurement or payment actions would be uneconomical. The form is to be used to summarize purchases and request replenishment of the fund. No other funds should be co-mingled with the petty cash fund. The fund should not be used for travel-related expenditures (i.e. advances, car rentals, per diem, conference fees and mileage reimbursements) and loans and services.

1. Period – Begin and end dates of claim

2. Petty Cash Advanced – Amount of fund

3. Cash on Hand – Balance

4. Expenses – Total of expenditures (receipts)

5. Cash reimbursement in Transit – A previous petty cash claim for which funds have yet to be received.

6. Total Petty Cash – Total of lines 2, 3, and 4 – total amount of the fund.

7. Submitted By – Signature of custodian; person designated by the principal investigator to safeguard, disburse and account for the fund. The principal investigator may not be the custodian.

8. Approved By – Signature of principal investigator and fiscal officer.

9. Project Name/Address – For campus addresses, provide the building name and room number. For off-campus address, provide the full mailing address.

10. Summary – Summarize each account by budget category dollar subtotals.

Please provide an itemized listing of receipts – List each receipt by account, budget category and description. Attach and number the original corresponding receipts. All receipts smaller than letter size should be taped to a 8-1/2” x 11” letter sized sheet. Amount claimed should be circled in red. Attach additional sheets as needed.