Travel Expense Reimbursement Request Form printable pdf download

Travel Expense Reimbursement Request Form

TRAVEL EXPENSE REIMBURSEMENT REQUEST FORM

Traveler’s name:

Employee Number:

Address:

(Please provide your home address for reimbursement, we cannot reimburse to your work/business address).

Location From/To:

Date(s) of Travel:

Purpose of Trip:

Private Car (Plate No.)

And Mileage:

Does Car have Liability Insurance:

Yes

One)

Departure Date/Time:

urn Date/Time:

Airline:

Domestic meals reimbursement:

(Based on actual receipts up to a daily maximum of $71/day)

Foreign per diem:

Lodging only:

(Telephone, Telegraph, Rental and Meeting Room, etc. are other expenses)

Taxi/Train/Bus/Shuttle:

Car Rental:

Parking, Tolls, Baggage:

Registration Fee:

Other Expenses:

TOTAL COST:

ACCOUNT OR PROJECT # to charge:

PLEASE PAPERCLIP ALL RECEIPTS ALONG WITH REQUEST FORM IN AN ENVELOPE.

Non-citizen, foreign visitors must present travel documents before they leave the U.S. The

business office must make photocopies of documents.

(Declaration of Immigration Status by Non-U.S. Citizens for foreign visitors)

I included the following receipts (check all that apply):

/Hotel

Other:

Travel Expense Reimbursement Request Form