Travel Expense Claim For Non Bc Government

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TRAVEL EXPENSE CLAIM
INVOICE #
FOR NON-BC GOVERNMENT EMPLOYEES
FORM USAGE
This form is for use by non-BC government employees to claim travel expenses. Refer to the attached Appendix 2 for guidelines and allowable
rates. After completion, the individual should forward the original claim form (with letter of agreement and receipts attached) to their ministry
financial contact. The qualified receiver will complete and sign the Coding section and forward the claim to Finance, Accounts for processing. A
cheque will be forwarded to the Cheque Mailing Address shown below.
CHEQUE INFORMATION
Payee Name:
Supplier #
Location Code:
Cheque Mailing Address:
Reason for Travel:
DATE
PLACES TRAVELLED
PERSONAL
BUS/TAXI/
MEALS:
ACCOMMODATION
MISCELLANEOUS
TOTAL
OF
VEHICLE USE
AIR/FERRY
B L
D
COSTS
(CAR RENTAL, PHONE, ATM FEES, ETC.)
DAILY
TRAVEL
DISTANCE x KM
COSTS
COST
DESCRIPTION
COSTS
20 ____
___________
RATE
M
D
FROM/TO (ENTER CITY NAMES)
KM
$
$
$
$
$
$
CLAIM TOTAL
CODING
Client: ___
Resp: ________
Svc Line: ________
STOB: 6005
Proj: ____________
_______________________________
__________________
Traveller’s Signature
Date
Certified this is a true statement of disbursements made to which I am entitled as
_____________________________
_____________________________
________________
a result of travel on government business as detailed above and for which I have
Qualified Receiver Printed Name
Qualified Receiver Signature
Date
not been and will not be reimbursed by any other party.
_____________________________________
Expense Authority Printed Name
FIN FSA 033 REV. MAY/05

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