Page 26 - GFSI-Cover Module 2

GREENTREE FOOD SOLUTIONS, INC.
PETTY CASH FUND ACCOUNTABILITY FORM

Date: _____________________

Custodian: Employee ID:

Contact No.: Email Address:

Responsibility Center: Department

Current Fund Amount Amount:

Establishment of Petty Cash Fund Amount:
(Please provide justification)

P ________ increase of petty cash New Amount:

P ________ decrease of petty cash New Amount:

Change custodian FROM _________________________ TO ____________________________

Close Petty Cash Fund

I, __________________________ , hereby acknowledge that I am the custodian of the Petty Cash Fund
for _______________________, in the amount of _____________. These funds will be maintained at
_______________________________.

I understand that I am responsible for safeguarding and maintaining accountability for these funds and
agree to keep personal funds separate and apart from Petty Cash Fund. I understand that I must submit
Petty Cash Fund reconciliation to my supervisor for his/her signature.

I also acknowledge that these funds will solely be used only for petty cash expenses related to the store.

Upon my job reassignment or termination from this Company, I agree to return these funds to GFS –
Finance.

Custodian Name & Signature:

Requested by Department Head:
Approved by Division Head:

Approved by General Manager: