Transfer Request Approval Form

TRANSFER REQUEST APPROVAL FORM

Document Identification

Request Number:   Date Submitted:

Parties and Requestor

WHEREAS, Transferor Name: is the current custodian of the assets or responsibility described below;

WHEREAS, Transferee Name: has requested acceptance of such assets or responsibilities under the terms set forth in this Request; and

WHEREAS, the Parties seek written authorization for the proposed transfer to ensure proper authorization, cost allocation, and compliance with applicable policies.

Transfer Details

Transfer Type: Asset Personnel Funds Other

Current Location:   Destination:

Quantity:   Asset Tag / Serial Numbers:

Requested Effective Date:   Requested Time (if applicable):

Scope of Work / Transfer Actions

Payment / Cost Allocation Terms

Transfer Cost Amount:   Billing To (Cost Center):

Late Payment Fee (if applicable):

Term, Termination, and Notice

Term Start Date:   Term End Date (if any):

Either party may terminate this transfer request for material breach or by providing written notice: Notice Period (days) . Upon termination, Parties shall cooperate to effect an orderly transition and final accounting of costs and returned assets.

Approvals & Operational Checks

Department Head Approval: Approved   Printed Name:   Date:

Finance Approval (if cost allocation applies): Approved   Printed Name:   Date:

IT / Security Clearance (if technology or protected data involved): Cleared   Printed Name:   Date:

Confidentiality and Data Handling

The Parties acknowledge that certain information, systems, or materials subject to this transfer may constitute Confidential Information. Each party shall maintain the confidentiality of such information and shall only use or disclose it as necessary to perform obligations under this transfer. Neither party shall disclose Confidential Information except to employees or contractors with a need to know and who are bound by confidentiality obligations at least as protective as those contained herein.

Representations, Liability, and Indemnity

Each party represents that it has authority to enter into this transfer, that any assets transferred are free of undisclosed liens (unless disclosed herein), and that it will comply with all applicable laws and internal policies. The transferor warrants the accuracy of the item descriptions to the best of its knowledge. Each party agrees to indemnify and hold the other harmless from liabilities arising from its negligence or willful misconduct in connection with the transfer.

Governing Law; Entire Agreement

This Transfer Request shall be governed by and construed in accordance with the laws of the governing jurisdiction specified by the Parties. This form, together with any attachments and approvals incorporated by reference, constitutes the entire agreement between the Parties with respect to the transfer and supersedes all prior negotiations and understandings, whether written or oral.

Amendments and Notices

Any amendment to this transfer must be made in writing and signed by authorized representatives of both Parties. Notices required under this transfer shall be delivered in writing to the printed names and departments identified on this form or to such other address as a party designates in writing.

Acknowledgment and Certification

By signing below, the Parties certify that the information provided in this Transfer Request is complete and accurate to the best of their knowledge, that they are authorized to request and approve the transfer, and that they accept the terms set forth in this document.

Sign Now