P-CARD PROGRAM
MISSING DOCUMENT AFFIDAVIT
This form should be completed for any P-Card transaction that does NOT have documentation from the merchant. This should be provided to Supervisor/Budget Head as part of budget cycle reconciliation paperwork.
Cardholder Name: Telephone Number: Phone:
Department:
Vendor/Merchant Name:
Transaction Date (month/day/year):
Transaction Amount (Total Cost):
Description/Quantity/Cost Per Item/Total Cost:
(Add an additional sheet if necessary):
Reason Original Documentation is Not Available
Cardholder Certification Signature:
I attest the information provided is true and an accurate description of the details of the purchase. I confirm that every attempt to obtain a duplicate receipt by contacting the vendor has been made, but have been unable to do so and also hereby certify the following:
| • | |
| All items purchased on this P-Card transaction were for Delgado Community | |
| College use. No personal purchases were made. | |
| • | |
| The Cardholder will not seek reimbursement from the Delgado Community | |
| College in any other manner for this transaction. | |
| • | |
| Original documentation is not in Cardholder’s possession for the reasons stated | |
| above. | |
| • | |
| Cardholder acknowledges that repeated lack of documentation could result in | |
| revocation of his or her P-Card. | |
| Cardholder Signature: ___________________________________ | |
| Date: ______________ | |
Supervisor/Budget Head:
I have accepted the cardholder’s explanation of the loss and inability to obtain a duplicate receipt; therefore, I am authorizing payment of the receipt or invoice in light of the circumstances involved.
Supervisor/Budget Head Print Name:
Supervisor/ Budget Head Signature: ________________________________ Date: __________
Form 3300/012 (7/12)