10. E. Expense Claim Form

Expense Claim Form 10.E - 10. Forms & Miscellaneous - E: Expense Claim
Do not fill the fields below - for administrative use only:
Date Paid

MonthDayYear
Date
Cheque #
Amount
Paid by
Expense submitter details
Expense claims & receipts are to be submitted to the OSA Treasurer within 60 days of the event or claim could be declined. Initially claims & receipts can be submitted electronically, but original copies of claim form receipts need to be sent to the OSA Treasurer within 60 days.
Date submitted*

MonthDayYear
Date
Name*
Position held*
Your Email*
example@example.com
Phone Number*

Area CodePhone Number
Expense details
Date of expense / event*

MonthDayYear
Date
Description of event*

AssemblyAWSCOther
Exchange rate to CAD used
Enter the exchange rate
Event title
Purpose of expense*

As attendantFor planningExecutive meetingAs organiser / coordinatorHand-overOther
Travel
Mileage is expressed in kilometers including return trip and expense claims are processed @ 50 cts per kilometer
Travel claims*

Not applicableEnter travel expense
Choose type of claim

MileageGasoline with receipt
Mileage traveled
Amount in KM
Claim ( Mileage multiplied by 0.50 )
Calculated amount in CAD
Gasoline (with receipt only)
Enter amount in CAD
Claim amount per km
Shared travel with
From
To
Claiming mileage from
To
Accommodation
Accommodation claims*

Not applicableAdd accommodation expense
Sharing room with # of roommates

123
Claiming # of nights
$ per night
Amount in CAD, Total to incude taxes
Claim
Amount in CAD
No accommodation needed - lives close to event; please enter # of km
# of nights covered by Ontario South Assembly (two (2) to a room)
Meals

Expenses are reimbursed for the total receipts, up to the maximum allowable, whichever is lowest. Unjustifiable meals will not be reimbursed (i.e., meals included at function – indicate as “provided”) Please enter amounts in CAD.
Meal claims*

Not applicableEnter meal expense
Date 1

MonthDayYear
Date
Daily expense guideline:

Daily total of $60.00 excluding alcoholic beverages

Date 2

MonthDayYear
Date

Date 3

MonthDayYear
Date

Total meal costs in CAD
Other expenses
(Specify and total on a different sheet)
Other claims*

Not applicableEnter other expense
Other costs
amount in CAD
Remarks about other expense
Advances
It is easy to forget we ever received a float or an advance by the end of the term, so please note below if a prior advance needs to be applied to this expense claim.
Advances to be deducted*

Not applicableEnter advance amount
Advance to be applied
amount in CAD
Advance received on

MonthDayYear
Date
Automated Summary of Expenses
Mileage
Mileage amount in CAD
Fuel amount (attach receipt)
Gas amount in CAD
Accommodation
amount in CAD
Meals
amount in CAD
Other
amount in CAD
Advance amount to be deducted from claim
amount in CAD
Total expenses to claim
amount in CAD
Should be Empty:

Expense details