THE HSWAGATA BUDDHA TOOTH RELIC PRESERVATION MUSEUM
FOR INTERNAL USE ONLY
Template No.: T177
Template Title: Donation Acceptance & Use Form (Cash)
Related Research Case IDs / Cluster: Cluster D (Everyday Faith & Lay Donations), Cases 36–45
Linked Templates / Policies: Donation Handling Policy, Finance/Receipting SOP, T176 (Lay Donor Registration), T164 (Workplan & Budget Summary), T170 (Compliance Self-Check), T173 (Records Classification)
Date of form: ____ / ____ / ______
Prepared by / Role: _______________________
Office / Unit: ____________________________
Country / Location: _______________________
Confidentiality Level:
Internal only [ ] Restricted [ ] Sacred-Restricted / Sensitive [ ]
Use of this form (tick):
New case / action [ ] Follow-up [ ] Annual review [ ] Archive only [ ]
1) Purpose (why we use this form)
This form records a cash donation and confirms how it will be used.
It supports transparency, gratitude, and careful records.
2) Donor and receipt link
Donor name (as preferred): _______________________________________
Donor ID / link to T176 (if any): _________________________________
Donor contact (optional, if needed for receipt): _____________________
Donation date received: ____ / ____ / ______
Time received: __________
Received at (location): __________________________________________
Received by (name/role): ________________________________________
3) Donation details (cash)
Currency: __________
Amount (numbers): ____________________
Amount (words): ________________________________________________
Cash type (tick): Notes [ ] Coins [ ] Mixed [ ]
Counted by (two-person check recommended):
__________________________ Signature: __________
__________________________ Signature: __________
Cash count confirmation: Correct [ ] Not correct [ ]
If not correct, explain: ____________________________________________
4) Purpose and intended use (how it will be used)
Donor purpose (tick one):
General support (museum priority use) [ ]
Specific purpose (write below) [ ]
If specific purpose, write clearly:
Internal planned use (department/program): ________________________
Planned budget line / code (if known): ___________________________
5) Conditions (if any)
Did the donor place any conditions on the donation?
Yes [ ] No [ ]
If Yes, list conditions clearly (simple words):
HSWAGATA acceptance decision:
Accept as stated [ ] Accept with adjustment (explain) [ ] Do not accept [ ]
If adjustment or do not accept, reason: _______________________________
6) Compliance and ethics check (quick)
Tick Yes/No and note if needed.
Donation is voluntary (no pressure). Yes [ ] No [ ] Notes: __________
Donation is lawful and not suspicious. Yes [ ] No [ ] Notes: ________
No conflict of interest known. Yes [ ] No [ ] Notes: _______________
Purpose fits museum values and peace/harmony. Yes [ ] No [ ] Notes: __
Any Sacred-Restricted condition requested? Yes [ ] No [ ]
If Yes, describe carefully (no sensitive detail here): ________________
If suspicious or high-risk, escalate to: Director [ ] Finance [ ] Board [ ]
Escalation date: //____ Person informed: _____________________
7) Bank deposit / finance recording (bank reference)
Deposit required by: Same day [ ] Next working day [ ] Other: ______
Cash deposit date: ____ / ____ / ______
Deposited by (name/role): ________________________________________
Bank name: _________________________________________________
Bank account (last 4 digits only): ____ ____ ____ ____
Deposit slip / bank reference number: _____________________________
Recorded in finance book/system? Yes [ ] No [ ]
Finance entry reference / voucher no.: _____________________________
Recorded by (name/role): ________________________________________
Date recorded: ____ / ____ / ______
8) Receipt and thanks (thanks sent)
Official receipt issued? Yes [ ] No [ ]
Receipt number: __________________________
Receipt date: ____ / ____ / ______
Receipt issued by (name/role): _________________________________
Thank-you sent? Yes [ ] No [ ]
Method (tick): SMS [ ] Email [ ] Letter [ ] In-person [ ] Phone [ ] Other: ____
Date thanks sent: ____ / ____ / ______
Sent by (name/role): __________________________________________
Public acknowledgment allowed? Yes [ ] No [ ]
If Yes, how (name list, plaque, report, etc.): _________________________
9) Notes (optional)
10) Signatures and approval
Received by (name/role): _______________________ Signature: __________ Date: //____
Count verified by (name/role): __________________ Signature: __________ Date: //____
Finance check (name/role): ______________________ Signature: __________ Date: //____
Approved (Unit Head/Director, if needed): ________ Signature: __________ Date: //____
11) Attachments and filing
Attachments (tick):
Copy of receipt [ ]
Deposit slip / bank proof [ ]
Donor condition note (if any) [ ]
Related memo/approval [ ]
File code / reference ID: ____________________
Classification recommendation: Internal [ ] Restricted [ ]
File location (cabinet/folder + digital path): __________________________
Retention period: 1 year [ ] 3 years [ ] 5 years [ ] 10 years [ ] Permanent [ ] Other: ____
