Financial Comment Form

FINANCIAL COMMENT FORM

Submitter / Originating Department

Reference Information

Reference Document Type: Invoice Purchase Order Journal Entry Financial Report

Document Number:    Document Date:

Fiscal Period: Month Year

GL / Account Code:    Project / Cost Center:

Amount Impacted:    Currency:

Classification and Materiality

Classification: Expense Revenue Asset Liability Equity Accrual / Adjustment

Material to financial statements: Yes No    If yes, explain materiality threshold and rationale:

Description of Issue / Analysis

Provide a concise factual description of the condition, variance, error, or question, including chronology and parties involved.

Proposed Accounting Entry (if applicable)

Debit Account:    Debit Amount:

Credit Account:    Credit Amount:

Impact Assessment & Recommendation

Expected impact on financial statements (select all that apply): Income Statement Balance Sheet Cash Flow

Adjust accounting records as proposed    Further investigation required    No change required / informational    Other (describe below)

Supporting Documentation / Attachments

Documents attached: Invoice Copy Purchase Order Contract Email Correspondence

Routing, Timelines & Controls

Action required: Post adjustment Policy review Tax review

Requested completion date:    Priority:

Compliance Attestation

By signing below, the submitter certifies that the information provided is true and complete to the best of their knowledge, that any proposed accounting treatment conforms with applicable accounting policies and internal control requirements, and that supporting documentation has been retained as required by corporate record retention policy. The submitter acknowledges that intentional misstatement or omission may constitute a violation of company policy and applicable law.

Requestor Certification & Signature

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