Fillable Employee Reimbursement Form

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Employee Reimbursement Form

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The Employee Reimbursement Form form is 1 page long and contains:

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  • 54 other fields

Country of origin: OTHERS
File type: PDF

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Employee Reimbursement Form
Name: ______________
Title: _______________
Employer: _____________
Dates of
Expense(s)
Payment Method
(Out of Pocket or by
Business/Corporate
Card)
Purpose of Expenditure(s):
Please give
detailed reasons for all expenditures.
#1
#2
#3
#4
Summary of Expenses
Description
(Date, Details,
Etc)
Air/Rail
Travel
Ground
Trans
Meals
Other
Total
#1
#2
#3
#4
Expense Report Total
I certify these are valid business expenses.
Reimburse/Cardholder Signature: ______________________
Reimburse/Cardholder Name: _________________________
Prepared by (Print): __________________ Date: ________________
I have reviewed these expenses and I believe they are true and
accurate.
Approved by (Print): __________________ Date: ________________
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Employee Reimbursement Form

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Completed 2 January 2021

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