Faculty Council Request for Payment (USC account)

Submit details receipts, invoices, or meeting minutes along with this completed form. One (1) new form for each request. Use this form for council member reimbursement and vendor payments. Please retain all original receipts until the reimbursement has been paid to ensure all documents are confirmed.

Today's Date: Today's Date: / MM / DD YYYY

Date of submission for the request
Your Name Your Name First Last
Your @uwo.ca Email

Enter your uwo.ca email only for club finance tracking purposes only.
Your Position
Faculty Council Name

If your council has a sub-account, use the five-digit account number for this.
USC account number

5-digit number found on the general ledger. Check if you are using the main account or sub-account.
Name of Event

As appears on Western Link
Date of Event (if it's a recurring event, please indicate date range)
Was the event proposal submitted?

Was the event proposal submitted? Yes N/A

Reimbursement requests are subject to having a submitted event proposal that has been reviewed by the USC staff. This is based on insurance purposes or ticketed events. The event proposal must also include an event budget to ensure the finances are updated.
Did the event proposal include an event budget?

Did the event proposal include an event budget? Yes No Don't know

The event budget is to ensure that expenditures are allocated for the event. If an event budget was not included, reimbursement payment will be delayed or not approved.
Who is this reimbursement for? Issue to (Legal Name or Company Name):
Issue in the Amount of: $ Dollars . Cents
Total amount of receipts or invoice total.
Is this a vendor payment?
(examples: bus, venue, catering, DJ, decorator, security, photographer, performer, hotel, merchandise supplier)
Vendor Invoice Number (quotes or estimates will not be processed)

Ensure that the invoice includes company name, date, invoice number, and HST registration number if taxed is charged.
Brief description of items purchased and its category for the event (eg. merch, decorations, food, etc.)
Maximum of 30 words allowed. Currently Entered: 0 words.
This description will be shown on the club's general ledger.
Signing officer signatures

Two signatures required. If you are a signing officer, you can't sign off on your own reimbursement.
Signing Officer #1 Signing Officer #1 First Last
Note, a signing officer cannot sign off on their own reimbursement.

Signing officers - President, VP Events, or VP Finance
Signing Officer #1 position
Signing Officer #1 UWO Email

UWO email ONLY
Signing Officer #1 Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Signing Officer #2 Signing Officer #2 First Last
Signing Officer #2 UWO Email

UWO email ONLY
Signing Office #2 position
Signing Officer #2 Signature (leave blank for second signature to sign if you are unable to sign at the same time)

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Payment/Reimbursement Option

Payment/Reimbursement Option E-transfer (must have auto-deposit) Cheque Pickup (USC Main Office, Room 340 UCC) Cheque to be mailed (complete address below) Other (Purchase Order, UWO invoice, USC internal, wire transfer, credit card)
E-transfer email address (no phone numbers)
Office Use: Payee sign on date of cheque pickup
Address (fill out only if cheque is to be mailed) Address (fill out only if cheque is to be mailed)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Upload complete receipts or invoices that correspond to the Request for Payment. Receipts must be clear and show company date, date of issue, and items purchased. High resolution images are preferred. Invoices are required as quotes cannot be processed. HST must be on the invoices. Partial receipts will not be accepted.

Receipts must be clear and show company date, date of issue, and items purchased. High resolution images are preferred.

Faculty Council Request for Payment (USC account)

Faculty Council Request for Payment (USC account)

Office Use: Payee sign on date of cheque pickup