Service Income Requisition
Print Form
We recommend completing the form electronically to take advantage of field formats, drop-down lists and totaling.
Instructions:
1) For a service income payment to an INDIVIDUAL as a guest lecturer/speaker, an academic reviewer, or for a contracted service.
2) Payments will NOT be processed unless the following documents are attached to this form:
a) Details describing the guest lecturer/speaker or academic reviewer service arrangement or
b) The completed signed copy of the "Certification Page" of the "Employment vs. Contracted Services Questionnaire" or the "Recurring Engagement/
Approved Contract Template / Certification Page" and the service provider's invoice.
3) Ensure all required fields are completed and then forward the form to Payroll, E70 - Administration Building.
4) Please allow 10 working days for processing from receipt in Payroll.
Surname
(Required)
First Name
(Required)
Preferred
Name
Middle
Name
Social Insurance
Number (Required)
Date of Birth
Employee ID
(If Applicable)
Residential or Off-Campus
Business Address
City/Town
Prov/State
Postal/Zip Code
Country
The cheque will be mailed to the address noted above. We will not mail to a campus address.
If amount is greater than $5,000.00 enter contract number
Enter Worker's Compensation Board number if applicable
CFOAPA - Required Coding
Item # Cht(1)
Fund(6)
1
Org(4)
Acct(5)
Optional Coding
Prg(4)
Acty(5)
AMOUNT
70403
Earn Code
723
1
1
1
TOTAL
Description / Explanation of University Business-Related Service Expense - reference the Item #(s) from above
Item #
Certification:
Your signature indicates certification as to the appropriateness and reasonableness of the amount being paid.
You also certify that, when required, a contract or approved template has been properly executed, in accordance with the
university's Signing Authority policy, and is on file in your department or in Purchasing Services, and that the service has
been received.
Requisitioner's Signature
Prepared By / For Information Contact (Please Print)
Date
Department / College
Phone
Approval: Your signature indicates approval as to the appropriateness and reasonableness of the expenses being claimed.
To the best of my knowledge, any expenses on this form identified as Tri-Agency related charges meet eligibility and compliance
requirements of the Tri-Agency and the University.
Approver's Signature
Please Print Name
Title
Date
Institutional Approval: (only required if any expenses are being charged to a Tri-Agency fund.)
Inst. Appr. Signature
Print Name
Date