Petty Cash Reconciliation Form
Use this form to reconcile petty cash funds by recording the period, cash count, expenses, supporting documents, and approval details.
Reconciliation Details
Reporting Period Start Date
*
 -
Month
 -
Day
Year
Date
Reporting Period End Date
*
 -
Month
 -
Day
Year
Date
Reconciliation Date
*
 -
Month
 -
Day
Year
Date
Petty Cash Fund Name or Location
*
Fund Custodian/Holder Name
*
First Name
Middle Name
Last Name
Department/Cost Center
Currency
*
Please Select
USD
EUR
GBP
CAD
AUD
Other
Cash Count and Transaction Summary
Opening Float / Starting Balance
*
Cash Counted on Hand
*
Total Vouchers / Receipts Submitted
*
Total Cash Disbursements Made
*
Reimbursements / Replenishments Received
Calculated Variance / Shortage / Overage
Reconciliation Status
*
Balanced
Shortage
Overage
Pending Review
Supporting Details and Approval
Itemized explanation of discrepancies or unusual items
*
Notes / comments
Upload receipts or supporting documents
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of
Reconciling employee name
*
First Name
Middle Name
Last Name
Reconciling employee signature
*
Reviewer / approver name
*
First Name
Middle Name
Last Name
Approver title / role
*
Approval date
*
 -
Month
 -
Day
Year
Date
Final approval status
*
Please Select
Approved
Approved with conditions
Rejected
Pending review
Submit
Submit
Should be Empty: