A reimbursement request should tell a reviewer what was bought, why, which fund pays for it, and who approved it. This form collects those facts once, in the same place every time.
The top block covers requestor, role, department, date submitted, expense period, business purpose, default program or fund, and any advance already received. Each expense line has a date, vendor, description and business purpose, category, program or fund, receipt status, and amount. There are five sample lines. Replace them with your own.
The total is a formula over the expense lines and one blank row. It does not include the total row. Insert new lines above the blank row so the formula grows. The advance is subtracted with formulas that show either the amount due to the requestor or the excess to return. The mileage line uses an example rate. Use the rate in your policy.
The requestor certifies the business purpose, the receipts, and the return of any excess or unused advance. Approval lines cover the requestor, the supervisor or budget holder, and finance review, with printed name, signature, and date cells to print and sign.
The form records the facts an accountable plan usually relies on. It does not decide whether a payment is taxable or how a person is classified. It is not a policy, and it is separate from the social club reimbursement policy. Educational only. Not legal, tax, or accounting advice.