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INTERNATIONAL TRAVEL REIMBURSEMENT REQUEST Date: Dept: Preparer: UC Employee Student Vendor Other: Name: Emp/Stu/Ven ID: Address: City/ST/Zip: E-Mail: Phone: US Citizen/Permanent Resident? Yes No If no, you will be contacted by CSS for more info. e.g. Passport, I-94,UC-W-8BEN,COAA ) Business Purpose (state date(s), location(s) and reason(s): Special Circumstances/Personal Time (state location & duration): Direct Bill? Yes (Attach Connexxus Itinerary) No (Attach Itinerary & Proof of Payment) Personal Car: (Standard Mileage Rate is 56 cents per mile for travel in 2014, and 57.5 cents for travel on or after January 1, 2015) TOTALS Rental Car: Economy/Compact/Intermediate Other Size Shuttle Bus Gas Parking Baggage Other Internet BART/Rail Taxi Toll Phone Conference/Registration Fee: Seeking Reimbursment? Yes No Conference/Registration Fee Amount: TOTAL TRAVEL EXPENSES: Requesting: Per Diem Actual Expenses Currency Location Breakfast Lunch Dinner Light Ref Lodging Travel Advance? Yes I certify that the above is a true statement, that the expenses claimed were incurred by me on official University business on the dates shown, and that I have attached original receipts for each expense as required by University policy. Traveler Name and Title: Traveler Signature: Date: Authorizing Name and Title: Authorizing Signature: Date: CF 2 $ Amount Accounting Approval Date (Dept Specific) Account Fund Dept Program CF 1 Amount Rate Drove To Address M&IE Totals Miles Drove From Address Date PAYEE TRIP TRAVEL EXPENSES DAILY EXPENSES T COA CERTIFICATION Air Fare: Seeking Reimbursment? Yes No (non meal) Air Fare Amount: (non meal) Paid on bluCard? Yes No Transportation & Other Misc. Expenses: LODGING TOTAL: M&IE TOTAL: LODGING & M&IE TOTAL: ESTIMATED REIMBURSMENT: Car Rental Amount: Reason for "Other Size" Car: Tips Other Other Tips * If additional space is needed, either attach another "daily expense" section or your own detailed spreadsheet of expenses * FORM AND RECEIPTS FOR ALL EXPENSES MUST BE SUBMITTED WITHIN 60 DAYS OF TRAVEL (*If paid on bluCard, do not enter amount*) Travel Advance Amt:

INTERNATIONAL TRAVEL REIMBURSEMENT REQUESTealc.berkeley.edu/sites/default/files/assets/International Travel... · international travel reimbursement request. date:dept: ... seeking

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Page 1: INTERNATIONAL TRAVEL REIMBURSEMENT REQUESTealc.berkeley.edu/sites/default/files/assets/International Travel... · international travel reimbursement request. date:dept: ... seeking

INTERNATIONAL TRAVEL REIMBURSEMENT REQUEST

Date: Dept: Preparer:

UC Employee Student Vendor Other:Name: Emp/Stu/Ven ID:Address: City/ST/Zip:E-Mail: Phone:US Citizen/Permanent Resident? Yes No If no, you will be contacted by CSS for more info. e.g. Passport, I-94,UC-W-8BEN,COAA )

Business Purpose (state date(s), location(s) and reason(s):

Special Circumstances/Personal Time (state location & duration):

Direct Bill? Yes (Attach Connexxus Itinerary) No (Attach Itinerary & Proof of Payment) Personal Car: (Standard Mileage Rate is 56 cents per mile for travel in 2014, and 57.5 cents for travel on or after January 1, 2015)

TOTALSRental Car: Economy/Compact/Intermediate Other Size

Shuttle Bus GasParking Baggage OtherInternet BART/Rail

TaxiToll Phone

Conference/Registration Fee: Seeking Reimbursment? Yes NoConference/Registration Fee Amount:

TOTAL TRAVEL EXPENSES:

Requesting: Per Diem Actual Expenses Currency Location Breakfast Lunch Dinner Light Ref Lodging

Travel Advance? Yes

I certify that the above is a true statement, that the expenses claimed were incurred by me on official University businesson the dates shown, and that I have attached original receipts for each expense as required by University policy.

Traveler Name and Title:

Traveler Signature: Date:Authorizing Name and Title:

Authorizing Signature: Date:

CF 2 $ Amount Accounting Approval

Date

(Dept Specific)Account Fund Dept Program CF 1

AmountRateDrove To Address

M&IE Totals

MilesDrove From AddressDate

PAYE

E TR

IP

TRAV

EL E

XPEN

SES

DAIL

Y EX

PEN

SES

TCO

A CE

RTIF

ICAT

ION

Air Fare: Seeking Reimbursment? Yes No

(non meal)

Air Fare Amount:

(non meal)

Paid on bluCard? Yes No

Transportation & Other Misc. Expenses:

LODGING TOTAL: M&IE TOTAL: LODGING & M&IE TOTAL:

ESTIMATED REIMBURSMENT:

Car Rental Amount:Reason for "Other Size" Car:

Tips

OtherOther

Tips

* If additional space is needed, either attach another "daily expense" section or your own detailed spreadsheet of expenses *

FORM AND RECEIPTS FOR ALL EXPENSES MUST BE SUBMITTED WITHIN 60 DAYS OF TRAVEL

(*If paid on bluCard, do not enter amount*)

Travel Advance Amt: