NEW YORK UNIVERSITY
EXPENSE REIMBURSEMENT FORM
(LAST REVISED JANUARY 2006)
Form EXP2000
For Accounts Payable Use
Only
This form is to be used only by NYU employees(including student employees) to request reimbursement for business expenses or to clear outstanding cash
advances.
NYU will not process requests for expenses that are deemed
nonpermissible/nonreimbursable
by the
University.
For guidance, refer to the Business Expenses Policy and Expense Reimbursement Policy of the
University.
If reimbursement is for travel, attach Form EXP2000T (reimbursement request for each trip must be submitted on a separate Form
EXP2000T).
If reimbursement is for meals during business meetings or events, attach Form
EXP2000M.
Otherwise, complete Box
12.
CASH REIMBURSMENT
.
Mark box if total expenses are $150.00 or less and you want reimbursement in cash. For cash reimbursement, take the form to the
Bursar’s Office. However, if an advance has been issued to you (line 9b), reimbursement of any amount should be processed through Accounts Payable.
PAYEE INFORMATION
1. PAYEE’S FULL NAME (FIRST NAME, MIDDLE INITIAL, LAST NAME)
For Accounts Payable Use Only
2.
HOME ADDRESS (REQUIRED: THIS IS YOUR PERMANENT MAILING ADDRESS)
3. ALTERNATE MAILING ADDRESS (IF APPLICABLE: THIS IS A SECONDARY MAILING ADDRESS)
7. HOLD FOR PICK-UP?
(For extraordinary circumstances
YES
only. Print name and tel. number.)
4. DEPARTMENT TO BE CHARGED
5. CONTACT PERSON (IF OTHER THAN PAYEE) AND TEL. NUMBER
EXPENSE/ACCOUNT DETAILS
TOTAL EXPENSES: 9a
LESS NYU ADVANCE: * 9b
EXPENSES NET OF
ADVANCES:
(9a – 9b = 9c) 9c
If amount in 9c is less than zero, please
attach
a check payable to
NYU.
If amount in 9c is greater than zero, 9c
must
equal
9f.
*NYU Advance: Refers only to any
cash
advance requested using
ADV3000.
PAY TO
NYU EMPLOYEE/STUDENT:
9d
PAY TO AMERICAN EXPRESS: (ATTACH
COPY OF AMEX PAYMENT STUB)
9e
TOTAL
REIMBURSEMENT
(9d + 9e = 9f) 9f
11. TOTAL AMOUNT OF REIMBURSEMENT (IN WORDS, AS YOU WOULD WRITE ON A CHECK)
12. DESCRIPTION AND BUSINESS PURPOSE OF EXPENSE/S
13. SIGNATURES/APPROVALS: I, the Payee, certify that the charges reported here are correct and that I am not claiming reimbursement from other
sources for the same.
SIGNATURE OF PAYEE (INDIVIDUAL COMPLETING
FORM)
PAYEE AUTHORIZING ANOTHER PERSON TO PICK UP
PETTY CASH (PAYEE’S SIGNATURE)
NAME OF PERSON TO PICK UP PETTY CASH
SIGNATURE OF PERSON TO PICK UP PETTY CASH (To
be signed in the presence of the teller or department
petty cash fund custodian at time of pick-up.)
For additional forms and instructions, see the Controller’s Division Web site (www.nyu.edu/cdv).
