OFF CAMPUS EQUIPMENT FORM
(ORIGINAL VALUE $5,000 OR MORE)
Name of Organization/Department
responsible for equipment
Banner Organization #
Date
Authorized Signature for Banner Organization
Signature of Person Accepting Equipment
Property Tag #
Description
Banner Organization #
Serial #
Name of Individual
Taking Custody of
Equipment
Date
Address Where Equipment Will be Located
Note: Individuals who are taking equipment off campus assume the risk of loss, and may be held liable for the replacement cost of equipment that is lost, stolen or
damaged. Your signature on this form is acceptance of the risk and the responsibility for the safekeeping of this equipment.
RETURN FORM TO GENERAL ACCOUNTING OFFICE, CAMPUS BOX 44
Questions? Contact Joe Tacoronte 351-2389
GAO Form PC-05
Revised 03/20/2013
This form is used when equipment with an original value of $5,000 or more is moved off campus. Individuals
who are taking equipment off campus assume the risk of loss, and may be held liable for the replacement cost
of the equipment if it is lost, stolen or damaged. Their signature on this form is acceptance of the risk and the
responsibility for the safekeeping of the equipment. Please provide the following information:
 The name of the Organization/Department responsible for the equipment
 The Banner organization number
 The date the equipment left campus
 An authorized signature for the Banner organization
 The signature of the person taking custody of the equipment
 The Banner organization number for the person taking custody of the equipment
 The date the equipment was accepted
 The UNC property tag number
 A description of the equipment
 The serial number if available
 The printed name of the individual taking custody of the equipment
 The address where the equipment will be located
Return the completed form to the General Accounting Office so inventory records can be updated