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Business Expense Form
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Your Email
*
Today's Date
*
Department
*
Admin Finance (0010)
Admin Operations (0050)
Admin IT (0040)
CRE (0100)
GHHN
Lead Physician (0150)
Management (0160)
Mental Health (0170)
Nursing (0180)
Nutrition (0190)
Pharmacy (0200)
Physician Assistant (0210)
Physiotherapy (0220)
Psychiatry (0230)
QI (0240)
Your Manager
*
Manager's Email
*
Expense Category
*
Kitchen supplies (i.e. milk, cream, sugar, etc.) – GL code 5375
HFHT
-wide events (i.e. event signage, decor, activity supplies, etc.) – GL Code 5381
Office supplies – GL code 5700
Executive leadership team expenses – GL code 5595
Local travel (i.e. bus tickets, train tickets, parking, etc.) – GL code 5785
Phone allowance (if not paid through payroll) – GL code 5007
Meetings (i.e. catering, professional printing, etc.) – GL code 5370
Postage and courier – GL code 5640
Subscriptions – GL code 5560
Expense Date
*
Description of expense (name of vendor and item purchased):
*
Reason for expense (i.e. lunch meeting with [name/committee] and why lunch needed, thank you gift for [name] and why, rush delivery of documents to [name], etc.)
*
Total amount (with HST):
*
HST portion:
*
read lunch a
Net Amount (Total minus HST)
*
Do you have the receipt for this expense?
*
Yes
No
Please provide an explanation of why you are unable to provide a receipt for this expense.
Please read the Missing Receipt Declaration below and check the box to acknowledge you have read it.
The Missing Receipt Declaration should be used on rare occasions and may not be used on a routine basis. Please make every effort to contact the vendor/merchant to request a copy of your missing receipt before submitting this form without a receipt. By clicking on the checkbox, you certify that the amount shown is the amount actually paid, and that you will not submit a duplicate claim.
Upload a receipt (please wait a moment while it uploads)
Click or drag a file to this area to upload.
OPTIONAL – Upload another receipt/invoice for this same expense (please fill out another form for a separate expense)
Click or drag a file to this area to upload.
Submit
