Single Dept/Service Reimbursement Form

Single Dept/Service Reimbursement Form

Please keep all original tax invoices until you have received your reimbursement.
Date

DayMonthYear
Date
Name (as per your Bank Account)*

First NameLast Name
Contact E-mail*
Your E-mail Address
Bank Details

Please provide one payment method: 1) Bank Account or 2) PayID
1) Bank Account BSB
Bank Account Number
Or 2) PayID
Mobile Number or Email
Department / Service
Department / Service*
If unsure, please ask your ministry leader.
Department / Service Coordinator*
If unsure, please ask your ministry leader.
Dept/Service Coordinator Email
example@example.com
Purpose of Expenses

Ensure that each expense listed is accompanied by a supporting tax invoice. Thank you.
Please indicate the purpose of the purchase, not just the company name shown on the receipt.

Examples: Hope Pantry, Conference Deco, SL Guest Relation Snacks, Christmas Fest F&B, Hope Kidz Classroom Resources, etc.

Receipt / Tax Invoice Details: *

TOTAL AMOUNT TO REIMBURSE ($)
This field is automatically calculated.
Total GST ($)
This field is automatically calculated.
Total without GST ($)
This field is automatically calculated.
Receipts / Tax Invoices

The following information must be clearly shown on all submitted receipts.
Upload All Receipts / Tax Invoices:

If your receipt/invoice is in another currency other than AUD, please also attach a screenshot of the bank or credit card transaction reflecting the amount charged in AUD.
Please keep all original tax invoices until you have received your reimbursement.*

Accepted file types: pdf, zip, jpg, jpeg, png, .heic. If the file size is too large (>50MB), you may need to compress and upload as .zip file or re-size the image/file.
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Please verify that you are human*
I confirm that all information provided above is valid and true.
For Office Use Only
Should be Empty:

Bank Details