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Ext.

SIGNATURE OF TRAVELER
PRINTED NAME
AUTHORIZED APPROVER SIGNATURE DATE
DATE DEAN or VP LEVEL SIGNATURE DATE
BANNER
INDEX
0.00 0.00
TOTALS
TITLE
PRINTED NAME
10.
Business
Meals
5.
Car Rental
and Gas
Expenses
4.
Mileage
amount to
Reimburse
Do not type on lines 39 - 41 unless prompted to do so.
0.00
Business Purpose for Expenses and Explanation of Request for Exception (if applicable):
6. Taxis,
Shuttles,
Airfare,
Baggage
Fees, Train &
other public
trans.
7. Tolls and
Parking.
8.
Per Diem
Amt.
2. Location at which expense was incurred. Points between which travel was
necessary & method of transportation used . Each days expenses must be shown
separately.
3a.
Miles
Driven
$0.00
0.00
$0.00
$0.00
$0.00
$0.00
$0.00
1.
DATE
PERSONAL DAYS WERE COMBINED WITH TRAVEL TO A FOREIGN DESTINATION
Zip:
3b.
Enter
Mileage
Rate
.560,
.565,
.246
TOTAL SHEET 2
0.00 0.00 0.00 0.00 0.00 0.00
AMOUNT
$0.00
$0.00
11. Reg./Mtg.
Fees
$0.00
9.
Lodging
Rate +
Taxes and
Fees
12.
Other (Itemize
in Column 2)
0.00
YES NO TYPE OF VEHICLE DRIVEN : PERSONAL RENTAL STATE OWNED
IF YES, ATTACH COMPLETED FOREIGN TRAVEL CERTIFICATION FORM WITH OTHER REIMBURSEMENT DOCUMENTATION.
I HEREBY CERTIFY THAT THE EXPENSES LISTED BELOW WERE INCURRED
BY ME ON OFFICIAL BUSINESS OF THE COMMONWEALTH OF VIRGINIA AND
INCLUDE ONLY SUCH EXPENSES AS WERE NECESSARY IN THE CONDUCT
OF BUSINESS. I UNDERSTAND THAT I MUST COMPLETE A FOREIGN TRAVEL
CERTIFICATION IF A PORTION OF MY FOREIGN TRAVEL WAS PERSONAL IN
NATURE AND UNDERSTAND THAT THIS MAY RESULT IN MY
REIMBURSEMENT BEING REPORTED AS TAXABLE INCOME.
ITEMIZED RECEIPTS FOR ALL TRAVEL AND FOOD EXPENSES OTHER THAN
MEAL PER DIEM, MILEAGE, AND QUALIFYING EXPENSES OF $25 OR LESS
HAVE BEEN INCLUDED WITH THIS REQUEST FOR REIMBURSEMENT. I
UNDERSTAND THAT IF ITEMIZED RECEIPTS WERE NOT SUBMITTED FOR
MEAL EXPENSES WHERE ALCOHOL WAS CONSUMED THAT THE TOTAL
AMOUNT OF THAT EXPENSE MUST BE PLACED ON LOCAL FUNDS. MY
SIGNATURE CERTIFIES THAT ALCOHOL PURCHASES HAVE BEEN CLEARLY
IDENTIFIED ON THIS REIMBURSEMENT.
TRAVEL and FOOD EXPENSE REIMBURSEMENT VOUCHER
REASON(S) FOR TRAVEL (select from drop down menu):
-
Banner ID or S.S.N.:
Rev 01/10/14
TOTAL DUE TO TRAVELER/ (TOTAL DUE BACK TO
VCU)
$0.00
TOTAL SHEET 3
AMOUNT ADVANCED
$0.00
GRAND TOTAL
$0.00
Print
Name
DEPARTMENT CONTACT INFORMATION:
State:
AUTHORIZED APPROVER CERTIFICATION
I HEREBY CERTIFY THAT THE TRAVEL UNDERTAKEN IN
THIS REIMBURSEMENT VOUCHER HAS BEEN REVIEWED
AND APPROVED AS NECESSARY FOR THE CONDUCT OF
BUSINESS OF THE COMMONWEALTH.
DEPARTMENT, INSTITUTION, OR AGENCY:
Address:
YES NO
VCU EMPLOYEE?
City:
Name:
Traveler's E-mail Address for Travel Receipt Notification:
DATE FORM COMPLETED
TRAVELER CERTIFICATION PAYEE PERSONAL INFORMATION SECTION - PLEASE COMPLETE ACCURATELY TO EXPEDITE PAYMENT
DATE
DATE
$0.00
0.00
$0.00
$0.00
$0.00
$0.00
$0.00
AMOUNT
$0.00
$0.00
$0.00
TRAVEL and FOOD EXPENSE REIMBURSEMENT VOUCHER
Rev 01/10/14
$0.00
$0.00
$0.00
DEPARTMENT CONTACT INFORMATION:
AUTHORIZED APPROVER CERTIFICATION
I HEREBY CERTIFY THAT THE TRAVEL UNDERTAKEN IN
THIS REIMBURSEMENT VOUCHER HAS BEEN REVIEWED
AND APPROVED AS NECESSARY FOR THE CONDUCT OF
BUSINESS OF THE COMMONWEALTH.
DEPARTMENT, INSTITUTION, OR AGENCY:
1.
DATE
2. Location at which expense was incurred. Points between which travel was
necessary & method of transportation used . Each days expenses must be shown
separately.
3a.
Miles
Driven
3b.
Enter
Mileage
Rate
.560,
.565
.246
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
4.
Mileage
amount to
Reimburse
5.
Car Rental
and Gas
Expenses
6. Taxis,
Shuttles,
Airfare,
Baggage
Fees, Train &
other public
trans.
7. Tolls
and
Parking.
11. Reg./Mtg.
Fees
8.
Per Diem
Amt.
9.
Lodging
Rate +
Taxes and
Fees
10.
Business
Meals
$0.00
Do not type on lines 33-35 unless prompted to do so. TOTALS
0.00 $0.00
$0.00
$0.00
$0.00 $0.00 $0.00
Explanation of Request for Exception:
DEPARTMENT CONTACT INFORMATION:
Print
Name
Ext.
NAME OF TRAVELER:
$0.00 $0.00
$0.00
Rev 01/10/14
$0.00
$0.00
$0.00
$0.00
12.
Other (Itemize
in Column 2)
TRAVEL and FOOD EXPENSE REIMBURSEMENT VOUCHER
AMOUNT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TRAVEL and FOOD EXPENSE REIMBURSEMENT VOUCHER
DEPARTMENT, INSTITUTION, OR AGENCY: NAME OF TRAVELER: DEPARTMENT CONTACT INFORMATION:
1.
DATE
2. Location at which expense was incurred. Points between which travel was
necessary & method of transportation used . Each days expenses must be shown
separately.
3a.
Miles
Driven
3b.
Enter
Mileage
Rate
.560,
.565
.246
Ext.
Print
Name
12.
Other (Itemize
in Column 2)
AMOUNT 6. Taxis,
Shuttles,
Airfare,
Baggage
Fees, Train &
other public
trans.
7. Tolls
and
Parking.
8.
Per Diem
Amt.
9.
Lodging
Rate +
Taxes and
Fees
10.
Business
Meals
11. Reg./Mtg.
Fees
4.
Mileage
amount to
Reimburse
5.
Car Rental
and Gas
Expenses
$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
Do not type on lines 33-35 unless prompted to do so. TOTALS
0.00 $0.00
Rev 01/10/14
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Explanation of Request for Exception:

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