Signature Form

Property Inventory and Warehouses Control Office
Personal Custody Declaration Form
To:
Property Inventory and Warehouses Control Office
From:
--------------------------------(Name of Department / Office)
Subject:
Declaring Personal Custody
Date:
---------------------------------
---------- -------------(Area)
(Cost Center)
Faculty/Staff Name: ------------------------------------------------------------------------------------------AUC ID no.: ----------------------------------------------------------------------------------------------------Item in Personal Custody: -----------------------------------------------------------------------------------Serial No.: -------------------------------------------------------------------------------------------------------Asset No.: --------------------------------------------------------------------------------------------------------Justification For the personal custody: --------------------------------------------------------------------I agree to assume responsibility for the above AUC property. I further agree to abide by the
recommended precautions as outline in Administrative and Faculty policies.
I further understand that I will reimburse the University should this equipment become lost, stolen,
or damaged while in my custody and as a result of my negligence. I am not relieved of this custody
until a signed copy of this form acknowledging the return of the equipment which is returned to me
by the Department Chair or the Appropriate Administrator. I understand the equipment is to be
returned on or before:
Faculty/Staff Signature:
Dept. /Org. Head Approval:
I acknowledge return of the above items.
Date of Return
Signature of Appropriate Designee
------------------------------------------------------------------------------------------------------------------------Please continue filling the form and forward to Property Inventory and Warehouses Control Office
after approving.
*Note: If there is no property number on the item, the serial number of the property is to be
used for identification.