Fillable Printable Employee Reimbursement Form
Fillable Printable Employee Reimbursement Form
Employee Reimbursement Form
Dept Code
TR NUMBER
Date(s) of Travel
Event Location: (City/State)
Date prepared
LOC FUND SUB
% split
Receipt
Direct Billed/
Prepaid
T&E CARD
PERSONAL
FUNDS
TRIP TOTAL
REIMBURSABLE
TO TRAVELER
Check if
Attached
Enter Total Miles
Approving Authority (Signature) Date Phone
EMP-T&E2015a
BRC Travel & Business Entertainment Summary - Employee Reimbursement Form
Estimated Totals
NOTE: This is an estimate of reimbursement.
Actual reimbursement will be determined by UC policy.
Travel Destination(s)
HOTEL / LODGING
IMPORTANT: if parking, food & incidentals are included on
hotel bill do not double enter in categories below)
Depart DATE/TIME
Enter Expenditures in
appropriate column
RENTAL CAR
Depart City :
Expense Exceptions or Detail
ACCOUNT
[BRC ONLY]
UCOP - Business Resource Center
1111 Franklin Street, 9th Floor,
Oakland, CA 94607
PERSONAL CAR BUSINESS MILEAGE
- Enter total miles in detail below.*
Travel Expense Detail
CONFERENCE REGISTRATION
Expenditures of $75 or above require original itemized receipts. Please secure all receipts with tape on 8 1/2 x 11 white paper in order of expense date & submit with this form.
Meals & Incidentals (totals carry over from page 2)
(M&I that is not included in hotel bill)
AIRFARE
AIRFARE Other Fees
- e.g. baggage fees, change fees
Depart City:
DEPT. NAME
Project
Arrival City:
Depart DATE/TIME
Meeting/Conference (full name):
Preparer Email
TRAVELER'S NAME
BUSINESS JUSTIFICATION
PURPOSE OF TRIP
Personal Travel part of this
trip? Yes No
PARKING
(that is not included on hotel bill)
Entertainment (manually type in amounts from page 2 totals)
MILEAGE: *Estimated Mileage
(Rate X Miles)
0.575
x Total
Approving Authority Statement: I approve this commitment of department funds for the stated University purpose. I certify that it is an appropriate use for the fund source and that
the transaction complies with University policy.
OTHER (Describe)
TOLLS
Total Ground Transportation: (totals carry over from page 2)
List dates of personal travel (airfare comparison for business portion of travel required)
Print Name
ADDITIONAL COMMENTS:
Auto Fill
Prepared by
RENTAL CAR GAS
Arrival DATE/TIME
Arrival City:
IMPORTANT: Please insert funds as appropriate indicating if expense was paid from personal funds, corporate card or
prepaid/direct bill. Please
DO NOT
enter any expense in more than one category below.
EXPENDITURES & REIMBURSEMENTS
PHONE
Event Dates:
Preparer phone
Source
Arrival DATE/TIME
*MILEAGE NOTE - As a general rule the basic mileage reimbursement guidelines are as follows:
Business travel on weekdays day or evening: UC reimburses business mileage in excess of normal commute expenses only.
Business travel on weekends or UC holidays: Report mileage from home to the destination using the most direct route.
Please see chart How mileage and ground transportation reimbursements are calculated for UCOP travelers for more detailed information
.
Date T&E Card
$
$
$
$
$
$
$
$
Carry over to Page 1
Estimated Total
M&I
Mode of Ground Transportation
From To T&E Card
$
$
$
$
$
$
$
$
$
Carry over to Page 1
Estimated Total
Ground Transp
Department:
Date T&E Card
$
$
$
Transfer these totals to Page 1
Estimated Total
Entertainment
empT&E2015 PG2a
Original itemized receipts required for all business entertainment expenses $75 or more. Ref: Appendix A (BUS-79) Per Person Maximums (pg 21)
Personal Funds
$
$
$
Travel Meals & Incidentals Details (G-28)
Business Purpose:
(Required)
Notes
$
$
Personal Funds
List meals & incidentals during travel. Ref: MEALS (G-28) Per Person Maximum
$
$
Number of Participants:
ATTENDEES: (Please attach list if needed)
Business Entertainment Desciption
Type of Expense:
Business Entertainment Reimbursement Details (BUS-79)
$
$
$
$
$
Additional Approval Required-Entertainment? Ref: Additional Approval (Appendix B BUS-79)
Title
$
$
Date Personal Funds
Name
Official Host:
$
$
Affiliation
Comments/Notes:
NOTE: Entertainment expenses require the business purpose, all attendees and job title, and affiliation for reimbursement.
