TRAVEL EXPENSES CLAIM FORM

(for use within client organisation only)

If you are claiming for fares you have paid for public transport or taxis, or any other form of
expense, please attach your tickets or receipts to this form. Business mileage only should be listed
below.

Name:

____________________________________________

Client Organisation:

____________________________________________

Department/Location:

____________________________________________

Date

From

To

Cost or
Distance

Description

Total Cost

Total Claimed
I declare that the details on this form are true and correct.
Signed: _____________________________________________

Date: ____/____/_____

Manager Approval: ___________________________________

Manager Name: ______________________________________

Date: ____/____/_____