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Receipt of Gift, Kickback, or Bribe

Recipient: Complete this form and present it to your supervisor with due contrition

1. Transaction interaction Item picture or description
Recipient ____________________________________________
Department _________________________________________
Giver _ _____________________________________________
Relationship to you: [choose one]
 client /  co-worker /  family /  friend /  lover
 I swear I never saw him/her before in my life

2. Compensation classification

 Gift [specify occasion] 4. Transmission disposition
 wedding, engagement, shower, bar/bat mitzvah, etc.
 birthday /  holiday /  attempted seduction Supervisor ________________________________________
Amount (%) you are tithing to supervisor ______________
 Kickback [specify project]  In kind /  Cash substitute

_______________________________________________ When can he/she expect the tithe? [specify time]
 immediately /  date/time ______________________
 Bribe [specify inducement expected]  whenever I get around to it
 fee adjustment /  expedited circumstances  when you pry it from my cold dead fingers
 wedding, engagement, shower, bar/bat mitzvah, etc.
This item’s value represents ____% of my annual pre-tax
income. In financial terms, its loss would be [choose one]
3. Valuation estimation  trivial /  important /  momentous /  catastrophic.

[Cash:] Given the chance to get it back, I would [choose one]
Amount __________________________________  shrug /  extend myself /  suffer untold agonies
 injure or kill someone /  do anything, that’s right,
ANN-NNY-THING
[Non-cash items, substances, etc.:]
Likely cost [For Human Resources tracking purposes]
Original _______________ / Replacement _____________ Attitude with which you render this tithe: [check all that apply]
c Humility, contrition
Extenuating characteristics affecting value c Lickspittle servility
Reduced value: c Reluctance
 poorly made /  obsolete /  tasteless /  stupid
c Irritation, mild annoyance
 broken /  damaged /  blood-soaked
c Homicidal fury
Increased value: c Sense of immense futility
 antique /  unique /  museum quality
c Other: __________________________________________
 unusually sturdy /  rare materials /  really cool
 once owned by celebrity (name) ___________________
 high Google PageRank
For office use only
Validation of compensation evaluation estimation:
Stolen? _________________________________________________
 yes /  probably /  unlikely /  unknown Rendition of transmission disposition:
If “yes” or “probably”: _________________________________________________
On a 1-10 scale, rate likelihood of original owner’s future Contrition?  yes /  no
involvement (1=owner unaware gift is missing, 10=police Resolution of contribution distribution:
outside right now): ________ _________________________________________________
Retribution?  yes /  no

Copyright ©2008 Ninjalistics. Written by Allen Varney. Answer further invasive personal questions on the many forms available free at www.ninjalistics.com