Travel Expense Claim Form Community Councils - Community Living British Columbia
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1COMMUNITY LIVING BRITISH COLUMBIA
TRAVEL EXPENSE FOR COMMUNITY COUNCIL MEMBERS
FORM USAGE
This form is used to claim travel expenses. Original claim form and applicable receipts must be attached as back up to the amounts claimed.
B
L
D
PERSONAL USE VEHICLE
BUS/TAXI/AIR/FER
ACCOMODATION
MISCELLANEOUS
DATE OF TRAVEL
PLACES TRAVELLED
MEALS
TOTAL DAILY COSTS
DISTANCE X KM RATE
RY COSTS
COSTS
(CAR RENTAL, BUS, PHONE, ETC.)
20___
M
D
FROM/TO (ENTER CITY
KM RATE:
$
$
$
COST $
DESCRIPTION
$
NAMES
$___________
Example
04
06
Victoria
100
50
00
71
00
47
00
168
00
Vancouver
CLAIM TOTAL
“Certified that the amount to be paid is correct, is in accordance with appropriate statute or other
authority for payment and/or contract; and, where applicable, that the work has been performed,
the goods supplied, the service rendered, and/or other conditions met.”
Spending Authority’s Name
Community Council Member’s Name
_____________________________________________________________________
__________________________________
_______________
Address, City, Postal Code
Receiver’s Signature
Date
Spending Authority’s Signature
Date:
Community Council Member’s Signature
Date:
For Office Use Only:
Resp. Ctr.:
Service Line:
STOB:
Project:
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