Business Expense Form - Hamilton Family Health Team

Name

First

Last

Your Email

receipt/invoice to the

Today's Date

Department

Your Manager

Manager's Email

Expense Category

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:

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.