HTML Preview Employee Reimbursement Form Simple page number 1.
Dept. Name:
Contact Person:
Address 1:
Address 2:
Phone #:
Email:
Employee's Signature Date
Total Reimbursement Amount
City/State/Zip:
Date of Expense
Amount
Name:
Address 1:
Address 2:
Request for Employee Reimbursement and Invoice (Other than Travel Expenses)
UNIVERSITY OF KENTUCKY
Employee Information
Department Information
For Reimbursement by SRM Requisition/Purchase Order this form much be transmitted to the Accounts Payable Department
via a Vendor Invoice and Credit Memo Transmittal.
For Reimbursement by Payment Request Document (PRD) this form must be attached to the PRD as part of the supporting
documentation.
http://www.uky.edu/Purchasing/docs/quickrefguide.pdf
http://www.uky.edu/eForms/forms/vendtrans-sap.pdf
I certify that the expenses listed above were incurred on behalf and exclusively for the benefits and business purpose of the
University of Kentucky.
http://www.uky.edu/Purchasing/docs/quickrefguide.pdf
To select the appropriate method for reimbursement, (SRM Requisition/Purchase Order or Payment Request Document)
please refer to the Purchasing/AP Quick Reference Guide.
Please provide a detailed description of the business purpose of each expense,
provide a complete explanation of why personal funds were used in lieu of the
standard University procurement process (Procurement Card, Purchase Order or PRD)
and attach an itemized receipt for each expense listed.
Address 3:
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