Fillable Printable Visitor's Expense Report
Fillable Printable Visitor's Expense Report
Visitor's Expense Report
Visitor’s Expense Report
An electronic VER is available, see the Online Voucher in the NUPortal
Department:
Request #:
Dept Cod e:
Request Date:
Dept. Contac t:
Voucher #:
Phone:
Visitor
Ven d o r Code:
Email:
VISITOR: Please Complete this Section Original receipts must be submitted for all cla imed exp enses
Visitor Nam e:
Business Purpose:
Address:
City, State ZIP:
Phone:
Date (s) of Travel or Expense From: To:
Expense Item
Des cription, Documenta tion Req u irements
Exp lanation of Expense
Amount
Air
Coach r ate; attach orig inal pas seng er recei pt
Rail
Attach original passenger receipt
Ground Transportation
Taxi, etc., attach original receipts and include tip
Automobile
Enter M ileage inc urred on or before 12/31/14:
Enter Mileage incurred on or after 1/1/2015:
@ 0.5 60 per mil e:
@ 0.5 75 per mile:
Parking Total:
Tolls Total:
Other Transport
Rental car, etc .
Hotel Room & Tax
Attach original hotel voucher
Meals
Attach original receipts, dinners may not exceed $65
per night, incl. tax and tip
Incidentals
Attach original receipts, gratuities & other mis c. items
Non-travel Expense #1
Non-travel Expense #2
Non-travel Expense #3
VISITOR: Certification S ignature Required
I certify that I have paid out these amounts for University-
related activities in support of the business purpose listed
and in accor danc e with Uni vers ity pol ic ies and pr oced ur es ,
that sponsored project expenses contain no charges for
alcoholic beverages or other unallowable items, and that I
have not previously received nor will I receive separate
reimbursement from Northwestern University or any other
entity for any charge I am submitting on this form.
Date
Visitor Signature
Total Expense
NORTHWESTERN UNIVERSITY USE ONLY Chartstring D istribution
\
Dea n o r Supervisor Area(s) Approval Required
I certify that these expenses were inc urred for University related activities and approve them as proper charges to
University acc ounts.
Print Name(s)
Signature(s)
Date
Fund
Department
Project
Activity
Program
CF1
Account
Amount
Revised 1/1/2015
