The University of Memphis
Claim for Traveling Expenses
Travel Claim Checklist | University Travel Policy | Click here for online help.
LINK FOR CONUS RATES
Name: Banner UID#: Dept: Phone:
PO No.: Blanket? Index No./Acct. Code: Period From: to
Campus Address (Home for Visitors):
Check Delivery: Direct Deposit Home Campus
A. EXPENSES PAID DIRECTLY BY THE CLAIMANT  (R)=RECEIPT REQUIRED
 
TRANSPORTATION
 
OTHER EXPENSES
 
DATE
PLACE LEFT
PLACE ARRIVED
MILES
MILEAGE AMOUNT
AIRFARE (R)
LODGING (R)
MEALS & INCIDENTALS
EXPLAIN & ITEMIZE BELOW
TOTAL
TOTAL A: 
COMMENTS



I certify this claim is true, all receipts are original, and all expenses were incurred on approved University business. I understand that I am responsible for maintaining original receipts, if not attached.
______________________________________
Claimant's Signature
_____________
Date
______________________________________
Resp. Official's/Designee's Signature

RO/Designee Name
_____________
Date
______________________________________
* Resp. Official's/Designee's Signature

RO/Designee Name
_____________
Date
(For expenses in Excess of PO amount)
______________________________________
Accounting Approval
_____________
Date
Prepared By (Please Print) Email/Ext
B. EXPENSES PAID DIRECTLY BY THE UNIVERSITY
DATE
EXPENSE
AMOUNT
AIRFARE
CONFERENCE
P-CARD (REGISTRATION ONLY)
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 U of M
BALANCE DUE CLAIMANT 
FOR SHARED SERVICES CENTER USE ONLY:

Prepared by:______________________________________ HD Ticket #______________________________ Revised Date:______________________________