HTML Preview Company Travel Expense Report page number 1.
I.
Subtotals
II.
III. Food and Lodging Reimbursement Methods
A.
1
Date: Date: Date:
BB
LL
DD
*G/U *G/U
B.
Actual Lodging: Use Actual Lodging Table under "A" and enter amount in Box "1"
Meal Allowance days @ per day =
C. days @ per day =
( Reimbursee's Signature ) Required
( Supervisor's Signature ) Required
G/U Amount
G/U Amount
Division of Financial and Business Services
University of Southern California, Business Services, Payment Services, UGB 210, Los Angeles, CA 90089-8015
Tel: (213) 740-2281 www.usc.edu/dc
TOTAL EXPENDITURES
THIS IS AN ACCURATE REPORT OF MY EXPENSES. THERE ARE NO "GOVERNMENT UNALLOWABLE" EXPENSES, AS
DEFINED ON PAGE TWO OF THIS FORM, UNLESS SEPARATELY IDENTIFIED ABOVE. ALL OTHER FUNDING SOURCES
FOR THIS TRIP(S) ARE IDENTIFIED ON THIS FORM AND REDUCED FROM THE TOTAL COST.
REIMBURSEE SIGNATURE REQUIRED.
Explanation Amount
Per Diem (Proof of Travel Required)
IDENTIFY OTHER FUNDING SOURCES (e.g., NIH, CO-SPONSOR) TO BE DEDUCTED FROM THE ABOVE:
Date
Amount
Pick Only One (A, B, C)
Actual Lodging and Meal Allowance
Amount
+(Indicate name(s) of guest (if any) and Business Relationship (Refer to appropriate amount above)
Amount
*G/U *G/U
AmountAmount
B
L
D
Date:
B
L
D
Meals (including tips) & *G/U Meal Expense (.e., alcohol)
Lodging
Rate
AmountDate of Trip
Dates: From / To
Type
Actual Lodging and Meal Expenses
# Days
Incidentals
Incidentals (explain) & Government Unallowables
Transportation
Company
Hotel
Disbursement Control
Travel Expense Report
Check Request# ___________Account# _______________________Department ___________________________________
Date
Date
Destination ______________________________________________ Period Covered ______________________________________
Business Purpose ____________________________________________________________________________________________
Instructions: Any single expenditure of $25.00 or more must have the receipt attached Mount all receipts on 8 ½ x 11 inch sheets of paper.
Submit this form and all receipts to Disbursement Control: UGB or Mailcode 8015. NOTE: Any “Government Unallowable” (G/U) expense must be
identified in the appropriate column(s) below. See page 2 of this document for definitions of “G/U."
AmountDate
dc-ter (Rev. 04-2013)
_________________
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Clear Form
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Clear Form
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Click here to see definitions of Government Unallowables.
Name
Reimbursee's