Receipt of Gift, Kickback, or Bribe

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

1. Transaction interaction
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

Item picture or description

2. Compensation classification

Gift [specify occasion]
 

wedding, engagement, shower, bar/bat mitzvah, etc. birthday /  holiday /  attempted seduction

4. Transmission disposition
Supervisor ________________________________________ Amount (%) you are tithing to supervisor ______________  In kind /  Cash substitute When can he/she expect the tithe? [specify time]  immediately /  date/time ______________________  whenever I get around to it  when you pry it from my cold dead fingers This item’s value represents ____% of my annual pre-tax income. In financial terms, its loss would be [choose one]  trivial /  important /  momentous /  catastrophic. Given the chance to get it back, I would [choose one]  shrug /  extend myself /  suffer untold agonies  injure or kill someone /  do anything, that’s right, ANN-NNY-THING
[For Human Resources tracking purposes]

Kickback [specify project]
_______________________________________________

Bribe [specify inducement expected]
 

fee adjustment /  expedited circumstances wedding, engagement, shower, bar/bat mitzvah, etc.

3. Valuation estimation
[Cash:]

Amount __________________________________
[Non-cash items, substances, etc.:]

Likely cost
Original _______________ / Replacement _____________

Attitude with which you render this tithe: [check all that apply]
       Humility, contrition Lickspittle servility Reluctance Irritation, mild annoyance Homicidal fury Sense of immense futility Other: __________________________________________

Extenuating characteristics affecting value
Reduced value:  poorly made /  obsolete /  tasteless /  stupid  broken /  damaged /  blood-soaked Increased value:  antique /  unique /  museum quality  unusually sturdy /  rare materials /  really cool  once owned by celebrity (name) ___________________  high Google PageRank

For office use only
Validation of compensation evaluation estimation: _________________________________________________ Rendition of transmission disposition: _________________________________________________
Contrition?  yes /  no

Stolen?

yes /  probably /  unlikely /  unknown

If “yes” or “probably”: On a 1-10 scale, rate likelihood of original owner’s future involvement (1=owner unaware gift is missing, 10=police outside right now): ________

Resolution of contribution distribution: _________________________________________________
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

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