Expense Claim Form

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Employee Information

Name:
Email:
Department:
Manager's Email:

Travel Date - From:
Travel Date - To:
Purpose of Trip:
Date Submitted:


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Details of Expenses

Transportation

Item Total Comments
Mileage: $ km
Tolls/Parking $
Car Rental $
Taxi/Limousine $
Airfare $
Other $
Subtotal $


Living Expenses

Item Total Comments
Hotel $
Meals $
Entertainment $
Other $
Subtotal $


Communications
Item Total Comments
Phone/Fax Charges $
Other $
Subtotal $


Applicable Taxes
Item Total Comments
Tax 1 $
Tax 2 $
Subtotal $


Summary
Total (all categories) $
Less Advanced Funds $
Total Claimed $