Expense Claim Form

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Expense Form

Name

Reason for Expense

Date

Receipts are required where applicable

Personal Vehicle use (0.61 per km x ____km)

Amount Personal Vehicle Use

Budget Account Vehicle Use (office use only)

Parking

Amount Parking

Budget Account Parking (office use only)

Taxi

Amount Taxi

Budget Account Taxi (office use only)

Airfare

Amount Airfare

Budget Account Airfare (office use only)

Hotel

Amount Hotel

Budget Account Hotel (office use only)

Ferry

Amount Ferry

Budget Account Ferry (office use only)

Meal # of Breakfast(s) ___x $10 each

Amount Breakfast Meals

Budget Account Breakfast Meals (office use only)

Meal # of Lunch(s) ___x $10 each

Amount Lunch Meals

Budget Account Lunch Meals (office use only)

Meal # of Dinner(s) ___x $10 each

Amount Dinner Meals

Budget Account Dinner Meals (office use only)

Other

Amount Other

Budget Account Other (office use only)

Total

Total Amount

Total Budget Account (office use only)

Date of submission

Date approved

Approved by

Signature

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