Microsoft Word - Funds Transfer Request Form

Unclaimed Property Office Funds Transfer Request Form

Purpose

The Columbia University Unclaimed Property Office (UPO) is able to return funds that no longer represent outstanding liabilities to the originating department.

Please provide all information requested below in order to expedite the processing of the transaction.

Directions

Please complete the highlighted portions of the form below. Once completed the form should be returned to the UPO via our web form, located at

http://finance.columbia.edu/content/UPO-Form. Please be sure to include a valid chart string where the funds can be credited and a brief explanation of why the

funds are no longer due to the owner.

Contact Information

Name: _________________________________ Department Name & Number: _________________________________________________________________

Phone Number: _____________________________________ Email: _________________________________________________________________________

Property Information

Item Number Amount Chart String to Credit Reason Funds No Longer Due

Certification

I hereby certify that the above information is correct and that the funds are no longer due to the owner.

Signature: _________________________________________________________________________ Date: ________________________________________