Free Excel Business Expense Report Form Template Download
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H C S
For Office Use Only Vendor No | ||
Voucher Id Date | ||
1099 Eligible Yes No | ||
PARTNERSTM
EALTH ARE YSTEM
Date Employee Business Expense Report (Appendix A-1)
Employee Information
Name Address SSN
Department
Explanation Of Business Purpose Section
Instance Date(s) Location
1
2
3
Summary of Expense Section
Description / Explanation
Daily Expense Amounts
Instance # | Dates | Description | Air | Ground Trans | Lodging | Meals | Alcoholic Beverages | Other | TOTAL |
$ - | |||||||||
$ - | |||||||||
$ - | |||||||||
$ - | |||||||||
$ - | |||||||||
$ - | |||||||||
$ - | |||||||||
$ - | |||||||||
$ - | |||||||||
$ - | |||||||||
$ - | |||||||||
$ - | |||||||||
$ - | |||||||||
$ - | $ - | $ - | $ - | $ - | $ - | ||||
Expense Analysis Section Less Advances Paid to Employee | Less advances paid to vendor(s) | Total Expense Non-PHS Reimbursement Total Owed Employee/(PHS) | $ - | ||||||
$ - | |||||||||
$ - | |||||||||
Prepared By Katherine Faherty | Expense Distribution | ||||||||
Bus Unit | (4 Digits) | Account (6 Digits) | Department (6 digits) | Phys ID | Prjct\Grnt (6 Digits) | Activity ID | Resource Type | Amount | |
Phone 617-525-3022 | |||||||||
Approvers Email | |||||||||
Payee Attestation Section | Total Check Request or (amount owed PHS) | 0.00 |
I certify that this report has been completed in conformity with the attached instructions and accurately describes the actual and necessary business expenses incurred in compliance
with PHS policies unless specifically noted. I have not received reimburse
If airfare expense has been charged to a federally funded grant, I further certify that best efforts were made to obtain the lowest reasonable commercial airfare for such travel.
Employee's signature
Date Email
I attest that no alcoholic beverages have been charged to a federally funded grant.
Approval Section
Approvers must be individuals senior to payee. Please see PHS policy and procedure for Employee Business Expense for more information regarding approvers and circumstances requiring Special Approval
General Approval | Special Approval | A/P Audit | |
Signature | |||
Print Name | |||
Title | |||
Date |
Reimbursement for CALGB Travel
Instructions for Filling Out the CALGB/Brigham & Women's/Partners Business Expense Report Form
April 2010
These instructions are intended for use by CALGB travelers authorized to be reimbursed by the CALGB Chair's Office for costs incurred while traveling on CALGB business
NOTE: The Travel Voucher is not prepared or submitted on-line.
Open the Partners Healthcare Business Expense Report Excel template.
* Click "enable macros"
*Enter the date
EMPLOYEE INFORMATION; Enter traveler's name, address, SSN (first expense report only, last 4 digits is acceptable. Enter CALGB in the space for department.
Explanation of Business Purpose Section: Enter departure and return dates, location, and description (i.e., Fall CALGB Committee Meeting).
Instance # | Dates | Description | Explanation |
#1 | 9/20-21/10 | Chicago, IL | CALGB Fall Committee Meeting |
SUMMARY OF EXPENSE SECTION: Each item has a row for entering expenses, fill in the boxes with the appropriate dollar amounts and add text under "Description", for example:
Instance # | Date | Description | Air | Ground Trans | Lodging | Meals | Alcohol | Other |
1 | 9/20/10 | Flight/Hotel/taxi | $320 | $40 | $179 | N/A | ||
1 | 9/21/10 | Taxi/Parking | $40 | $48 |
EXPENSE ANALYSIS SECTION: do not complete
PAYEE ATTESTATION:
Enter date and email address for correspondence related to payment status
Check the attestation that alcohol is not included in the expenses to be submitted
Parking
PRINT AND SIGN FORMS, MAIL COMPLETED FORM, ALL ORIGINAL RECEIPTS AND BOARDING PASS/ITINERARY TO:
Katherine Faherty
CALGB Office of the Group Chair 75 Francis Street
Thorn 417B Boston, MA 02115
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