Reimbursement Form

Receipt Reimbursement Form

DIRECT DEPOSIT SHOULD BE PAID TO:

First name

Last name

Position

General Ledger Number (Ministry to be charged)

Designated Budget

Ministry Name

Additional Information

We will be paying reimbursements twice a month on the 10th and 25th. Any reimbursements turned in between the 21st of the previous month and the 5th of the current month will be paid on the 10th. Any reimbursements turned in between the 6th and the 20th of the current month will be paid on the 25th.

Please indicate the ministry/department this affects as well as the GL account number it will be debited from on your receipt. Upload either a picture or a document of your receipt as indicated below.

Upload File

Did you purchase food or beverage? (Yes/No)

If yes, please list who consumed the food or beverage:

Total amount to be reimbursed:

Receipts must be attached for payment.

Your Signature

DUE DATE