Expense claim (out of town)

Out of town assignment expense claim
Email
exemple@exemple.com
Date
Name

First nameLast name
Union card number
Assignment date
Departure date
Return date
Total number of days
Address

Number and street

Address complement

CityProvince

Zip code
Phone number
Format: (000) 000-0000.
Nature of assignment
Milleage in town
Enter amount
Parking in town
Enter amount
Ticket (airline, train, bus)
Enter amount
Airport fees
Enter amount
In town taxi
Enter amount
Other
Enter amount
Mileage out of town
Enter amount
Taxi out of town
Enter amount
Parking out of town
Enter amount
Perdiem
Enter amount
Hotel
Enter amount
Phone calls
Enter amount
Total amount
Enter amount
Cash advance
Enter amount - If $0 enter 0
Refund to lodge
Enter amount - If $0 enter 0
Claim from lodge
Enter amount - If $0 enter 0
All expenses claimed will be paid accordingly to Airline Lodge 1751 Bylaws. Don’t forget to include your receipts.
Member's signature
Receipts

Include your receipts
Cancelof
Should be Empty:

Out of town assignment expense claim