The University of Memphis
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
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 for one year.

     
______________________________________
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:______________________________