Fund Admin approval & date:

Supervisor approval & date:

AP approval & date:

Manager approval & date:

RESERVED FOR FINANCIAL SERVICES USE:

PAYEE INFORMATION

Address:

Pay To:

City:

PAYMENT REQUEST DETAILSIf payable to an individual, please select one:

Refund Participant Fee

Province/State:

If not Canada or USA then fill in Postal/Zip and the Country

Postal/Zip: Country:

Purpose (Indicate the purpose of the cheque):

Allowance

Other - Please specify:

USD$CAD$Currency:

Other Currency - Please specify:

Request date:

Please forward signed form to Accounts Payable, Financial Services, 3465 Durocher St., 2nd floor, Montreal, Quebec, H2X 0A8. Accounts Payable will not process a Payment Request until the duly signed paper form and supporting documentation is received. Please ensure that invoices are addressed to McGill University. Payment Requests ONLY permitted for payments to public/health institutions, government offices, life insurance, McGill student societies, participant fees, living allowances, refunds, payments made on behalf of Trust Funds.

PAYMENT REQUEST FORM

EXPENSE FOAPAL At least one FOAPAL and Amount is required.

1 Fund Org Acct Prog Actv LocnAmount 1:

GST1*:

Amount 2:

2 Fund Org Acct Prog Actv LocnGST2*: QST2*:

Amount 3:

3 Fund Org Acct Prog Actv LocnGST3*: QST3*:

Amount 4:

4 Fund Org Acct Prog Actv LocnGST4*: QST4*:

TOTAL:

*GST and/or QST if applicable

AUTHORIZATION - FUND FINANCIAL MANAGER (S) OR DELEGATE

REQUESTED BY

Name: Unit:

Email: Telephone:

Print name and sign (wet signature ONLY):

Additional information may be entered on Page 2.

QST1*:

v.2019.04.05

**If signed by a delegate, provide: FFM McGill ID Delegate McGill ID

Fund Org Acct Prog Actv LocnGST5*: QST5*:5Amount 5:

Other

Ensure banking information is on invoice or complete Wire Transfer Request Form

Date

PAYMENT REQUEST FORM

Additional Information (optional):