Ref. #  	

Turnover Form

TO	:	University Research Coordination Office

FROM :	 	

RE	:	Turnover of Equipment/Apparatus/Materials

************************************************************************************************ Source of funds:
	Internal; Pls. specify  	

	External; Pls. specify  	

This is to certify that the following item/s which was/were purchased using funds from Project No.	:  	
Project Title	:  	

Proponent(s)	:  	

Department	:  	

has/have been turned over to the This/These item/s is/are as follows:

Received by:

(Signature over Printed Name/Date)

Cleared by ITC:
(Signature over Printed Name/Date)

Transfer Form #: