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DATE SENT
[Company Name] EXPENSE VOUCHER MONTH/YEAR
[Company Address] OFFICIAL STATION
Tel: [ Tel. No] / Fax : [ FAX No.]
[Website Address] OFFICIAL RESIDENCE

REIMBURSEMENT BASIS
TRIP INFORMATION ENTITLEMENT
PURPOSE OF TRIP
MILES DRIVEN
DATE ROOM GRAND INCLUDE EXACT TIME
DEPART RETURN TOTAL TOTAL OTHER
FROM TO B L D COST IN PERSONAL CAR TOTAL OF ACTIVITY
TIME TIME
PT TO PT VICINITY RATE AND LOCATION
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00

TOTALS 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
DETAIL OF OTHER EXPENSES TRAVELER STATUS COMMENTS ACCOUNTING INFORMATION
DATE PAID TO FOR AMOUNT ADJUNCT SPEEDTYPE ACCOUNT AMOUNT
ADMINISTRATOR
CIVIL SERVICE
FACULTY
OTHER______________

APPROVED BY
TOTAL 0.00 TOTAL 0.00
SIGNATURE OF TRAVELER CHECKED AND APPROVED FOR PAYMENT BY DATE TOTAL AMOUNT APP VOUCHER NUMBER WARRANT NO

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