Expense Reimbursement Form

Submitted by *

First Name Last Name
E-mail *
Project Related
Expense Purpose *
Cost *
Amount in USD $
Expense Date *

Month Day Year
Are you a software engineer for Khalis?

Yes No
Product
Achievements
Please list 2-3 of your achievements during this pay period.
Receipt(s) *
Reimbursement

Zelle Paypal Payoneer US Tax Deductible Receipt only
E-mail Address for Reimbursement
Additional Information:
Should be Empty: