Lost Receipt Form - University Of Windsor printable pdf download

Lost Receipt Form - University Of Windsor

Accounts Payable

LOST RECEIPT FORM

I hereby certify that the original receipt was lost, accidentally destroyed or unobtainable and that the

information detailed below is complete and accurate.

Receipt Information:

Date of Receipt: _______________

Total Amount of Receipt (including taxes): $____________

Vendor Name: ____________________________________

Description of Goods and/or Services:

______________________________________________________________________________________

Reason Receipt Was Lost: ____________________________________________________________

Alcohol Charges:

Yes

If a “lost” meal receipt, does the receipt cover more than one individual? If so, please note individual

name(s) and business purpose:

______________________________________________________________________________________

_____________________________

___________________________

Claimant Signature

Claimant Name

SUBMIT OR E-MAIL

BUTTON

____________

Date

Please attach this form to your Travel Expense Form

Submit Form To: Senior Clerk Accounts Payable - Rob Dobson (rdobson@uwindsor.ca)

If there are any questions while filling out the form, please contact Rob at ext. 2120

Revision Date: May 2012

Lost Receipt Form - University Of Windsor