Expense Form

Expense, Honorarium, and Per Diem
This form is for reimbursements of expenses, honorarium, and per diem only.

Do not use this form for processing bills, donations, or committee fund adjudications. This form can only be used by CUPE 3903 members and CUPE 1281 staff members.

Email Transfer only: CUPE 3903 uses Plooto to facilitate electronic fund transfers.

Contact Email: cupe3903office@gmail.com and sectreasurer3903@gmail.com
Member/Staff Information
Payment Request From: *

Given Name(s)Surname(s)
I am a staff member (CUPE 1281)

Yes
York Employee Number*
This number begins with either 100, 101, or 102
Non-York Email*
You will not be able to submit this form if you use a York email address
It looks like you've entered a York email address. Please enter a non-York email address to submit this form.
Phone Number*
Name of payable (if different from request name)

First NameLast Name
Or if payable is to an organization
Organization Name
Email contact of payable (put more information in notes if needed)
Email of payable
Expense Details

Expenses List (Complete Every Row in Full)*

Total Claim*
Upload all documentation here*

Cancelof
Notes
Please provide any additional information required to expeditiously process this expense
Submission
I certify*

I certify that all information entered above is valid and true and that the amounts shown on this statement were incurred by me on behalf of CUPE and/or Local 3903.
Signature*
Type out full name in lieu of signature
Date and Time of Submission (Read Only)

MonthDayYear
Today's Date
Hour Minutes
For Administrative Use Only
Verified Claim

YesOn HoldRejected
Processing Notes
Date Entered in Plooto

MonthDayYear
Date
Signing Authority #1
Typed signature (approval)
Signing Authority #2
Typed signature (approval)
Should be Empty:

Expense, Honorarium, and Per Diem