Claim for Traveling Expenses

- PLEASE PRINT IN LANDSCAPE FORMAT

INSTRUCTIONS
University Travel Policy | CONUS Rates | OCONUS Rates | International Rates

Name: Banner UID#: Department: Phone:
PO No.: Blanket? Index No./Acct. Code: Period From: to
Remittance Address: Check Delivery: Direct Deposit Home Campus

A. EXPENSES PAID DIRECTLY BY THE CLAIMANT
			TRANSPORTATION					OTHER EXPENSES
DATE	PLACE LEFT	PLACE ARRIVED	MILES	MILEAGE AMOUNT	AIRFARE	LODGING	MEALS & INCIDENTALS	EXPLANATION	AMOUNT	TOTAL
Date1	Depart1	Arrive1	Miles1	Mileage1	Airfare1	Lodging1	Meals1	Explain1	Itemize1	Total1
Date2	TDepart2otal1	Arrive2	Miles2	Mileage2	Airfare2	Lodging2	Meals2	Explain2	Itemize2	Total2
Date3	Depart3	Arrive3	Miles3	Mileage3	Airfare3	Lodging3	Meals3	Explain3	Itemize3	Total3
Date4	Depart4	Arrive4	Miles4	Mileage4	Airfare4	Lodging4	Meals4	Explain4	Itemize4	Total4
Date5	Depart5	Arrive5	Miles5	Mileage5	Airfare5	Lodging5	Meals5	Explain5	Itemize5	Total5
Date6	Depart6	Arrive6	Miles6	Mileage6	Airfare6	Lodging6	Meals6	Explain6	Itemize6	Total6
Date7	Depart7	Arrive7	Miles7	Mileage7	Airfare7	Lodging7	Meals7	Explain7	Itemize7	Total7
Date8	Depart8	Arrive8	Miles8	Mileage8	Airfare8	Lodging8	Meals8	Explain8	Itemize8	Total8
Date9	Depart9	Arrive9	Miles9	Mileage9	Airfare9	Lodging9	Meals9	Explain9	Itemize9	Total9
Date10	Depart10	Arrive10	Miles10	Mileage10	Airfare10	Lodging10	Meals10	Explain10	Itemize10	Total10
Date11	Depart11	Arrive11	Miles11	Mileage11	Airfare11	Lodging11	Meals11	Explain11	Itemize11	Total11
TOTAL A:

COMMENTS

I certify this claims is true and all expenses were incurred on approved University business.


______________________________________ Claimant's Signature	_____________ Date	______________________________________ Fin Manager/Designee's Signature (1st Index)	_____________ Date
______________________________________ Fin Manager/Designee's Signature (2nd Index)	_____________ Date	______________________________________ Fin Manager/Designee's Signature (3nd Index)	_____________ Date
If Balance Due Claimant is more than the original PO amount do one of the following: If authorizing payment of funds in excess of PO amount sign here: _______________________________________________ If NOT authorizing payment of amount over PO initial here: __________ Claim Prepared By Email/Ext

B. EXPENSES PAID DIRECTLY BY THE UNIVERSITY
EXPENSE	AMOUNT
AIRFARE
CONFERENCE
HOTEL/RENTAL CAR
OTHER
TOTAL B:
*TRAVEL PURCHASE ORDER AMOUNT

TOTAL EXPENSE(Sum of A+B)
LESS PREPAID BY U of M (Subtract B)
LESS TRAVEL ADVANCE RECEIVED
PAYMENT DUE UofM
BALANCE DUE CLAIMANT

FOR SHARED SERVICES CENTER & ACCOUNTING USE ONLY:

Audited by:______________________________________ Date:______________________________ Payment Processed By:______________________________

Last Updated: 10/26/24