PETTY CASH EXPENSE REIMBURSEMENT
ONLY TO BE USED FOR AMOUNTS
LESS THAN $50.00
Name
Date Submitted
Department Telephone No.
DETAILS OF EXPENSES
Reimbursement will only be made for expenses allowed under the Purchasing Policy
and Travel and Entertainment Policy.
1. - - receipts required
ENTERTAINMENT OF GUESTS (include tips, attach receipts)
NATURE OF EVENT/ LIST OF ATTENDEES:
(# of guests,# of employees,# of students,# of employee spouses)
OTHER (attach receipts)
NATURE OF EXPENSE
2. - - no receipts required (calculate deemed HST, Column Ax Column B)
DATE OF TRIP
NATURE OF TRIP
PERSONAL AUTOMOBILE - Kilometres @ $.39 per km
EMPLOYEE TRAVEL MEAL ALLOWANCE (maximum $48/day, B - $10, L - $14, D - $24)
MISCELLANEOUS TRAVEL (parking, bus, subway, tokens: max $10/day)
I hereby certify that the above is a correct statement of
expenses which were incurred on University business
TOTAL EXPENSE
SIGNATURE OF CLAIMANT
COUNTERSIGNATURE
FINANCIAL
SERVICES
(A)
Total Amount
HST Included
(B) (C)
Amount of
HST Only
15/115
15/115
15/115
The charge to the department will be the
net HST amount as calculated by Financial
Services.
CHARGE EXPENSE TO - (Claimant to complete)
(1)
Complete
Account No.
(2)
Total
Amount
Column (A)
FINANCIAL SERVICES USE ONLY
(3)
HST
Amount
Column C
(4)
HST
Rebate
(3) x 31.26%
(5)
Net HST
Charge
(2) - (4)
INVOICE #
VOUCHER #
Verified Approval
Cash Received
Claimant must sign here indicating cash was received from Petty Cash Custodian Revised May 1, 2013
0.00
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