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Employee Reimbursement Form: Name: - Title: - Employer

This employee reimbursement form allows a staff member to request repayment for approved work-related expenses. The employee provides their name, title, employer, dates and payment methods for each expense. They also give details on the purpose and amounts for airfare, transportation, lodging, meals and other costs. The employee and their supervisor must both sign to confirm the validity and accuracy of the expenses before reimbursement is provided.

Uploaded by

Muhammad Bilal Khatami
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© © All Rights Reserved
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129 views1 page

Employee Reimbursement Form: Name: - Title: - Employer

This employee reimbursement form allows a staff member to request repayment for approved work-related expenses. The employee provides their name, title, employer, dates and payment methods for each expense. They also give details on the purpose and amounts for airfare, transportation, lodging, meals and other costs. The employee and their supervisor must both sign to confirm the validity and accuracy of the expenses before reimbursement is provided.

Uploaded by

Muhammad Bilal Khatami
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Employee Reimbursement Form

Name: ______________
Title: _______________
Employer: _____________

Dates of Payment Method Purpose of Expenditure(s): Please give


Expense(s) (Out of Pocket or by detailed reasons for all expenditures.
Business/Corporate
Card)
#1
#2
#3
#4

Summary of Expenses
Description Air/Rail Ground Lodging Meals Other Total
(Date, Details, Travel Trans
Etc)
#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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