PM- Expense Form

Reimbursement of Expenses for Employees, Contractors and Volunteers

Pacific Mountain Region - The United Church of Canada
Pay to:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email:
example@example.com
Requested by:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Event Name:
Approved by:
Please enter name of Pacific Mountain Region staff that will be approving this expense
Event Start Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Event End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Expense Costs
Travel Start Location
For travel expenses, indicate where your trip started.
Mileage:
Please enter actual mileage in Km. Form will automatically multiply Km entered by $0.60 a Km.
Mileage Sub Total:

Expense Cost

Rows	Category	Purpose	Vendor	GST/HST	Total Amount (including taxes)
Calculated Mileage
Item 1
Item 2
Item 3
Item 4
Item 5
Item 6
Item 7
Item 8
Item 9
Item 10

* If you have more than 10 items please use an additional form
Notes/Comments
If necessary
Total Costs
Donate this amount of my reimbursement to Pacific Mountain Region
Total Claim
Attach PDF/Doc/JPG/Excel files with your receipts (except for mileage you should have receipts for any other expenses.)

Select Files

Cancelof
Register for EFT

Payment of expenses are being made by Electronic Funds Transfer (EFT).
- Download direct deposit fillable PDF form by clicking here.
- Fill in form and save your answers.
- Email your filled in EFT form to finance.pacificmountain@united-church.ca
I acknowledge that:
Expense Guideline

Please download and read the Voluteer Expense Guideline 2021. You can download the guideline Here
I acknowledge that:
Air/Ferry:
Please enter the amount in Dollars for the air or ferry expenses covered. Please include receipts for this expense.
Meals:
Please enter the amount of in Dollars for meals. Please include receipts for this expense. Please note there is no reimbursement for alcoholic beverages.
Accommodation:
Please enter the amount in Dollars. Please include receipts for this expense.
Other:
Please enter the amount in Dollars. Please include receipts for this expense.

Travel Costs

Rows	Amount / Km
Ferry/Air/Bus/Taxi ($ amount)
Auto Km (enter actual km, form will multiply km @ $0.40 automatically in subtotal)
Meal and Accommodation ($ amount)
Other ($ amount)

Office Use Only

Reimbursement of Expenses for Employees, Contractors and Volunteers