Expenses Claim Form
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Page 1 of 3 Expenses Claim Form Important This Expenses Claim should be logged with Grid-Servers LTD as soon as possible after purchase of items Use a separate form for each separate inventory This form must be sent to Head office for approval. Details of Employee Contact Telephone: Employee Name: Email Address: Department: Line Manager: Employee ID: Date of Request:
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Basic Expensive claim form
Transcript of Expenses Claim Form
Page 1 of 3
Expenses Claim Form
Page 1 of 3
Expenses Claim Form
Important
This Expenses Claim should be logged with Grid-Servers LTD as soon as possible after purchase of items Use a separate form for each separate inventory This form must be sent to Head office for approval.
Details of Employee
Complete Sections 1 to 4 to the best of your ability
Do not fill in section 5, this is for head office use
Employee Name:
Department:
Contact Telephone:
Email Address:
Line Manager:
Employee ID:
Date of Request:
1.Item Name 2.Value 3.Reason for Claim 4.Date 5.Authorised By
Items Being Claimed
Declaration by the employee
The information I have provided in this form is true and accurate. I am aware that giving false or misleading information, documents or statements is a serious offence under the Commonwealth’s Criminal Code 1995 and that this Imposes substantial penalties, Including imprisonment , for committing these offenses. Any entitlement provided to me as a result of such conduct may not be recovered.
Signed:Print Name:
Page 3 of 3
Expenses Claim form
Head Office Use Only
When Lodging an Expenses Claim provide as detailed a description as possible of the item that is being claimed for.
Grid Servers LTD, subject to terms of its Warranty and Insurance, will attempt to re-imburse all employees who have spent personal money on business equipment where possible.
We will Review your claim and decide on the appropriate path to take. You will be kept informed with every step of the process.
Disallowed Items
Unfortunately due to legal, corporation and insurance restrictions, certain items are exempt from being claimed. In these circumstances, the claimer will be consulted and advised of the appropriate path to take.
THIS FORM SHOULD BE COMPLETED AND SENT TO:
Grid-Servers LTD.8 Castle WalkDidcotOxfordshire OX11 7PD
Email: [email protected]: 01235210359
Authoriser Name: Date:
Number of Items Authorised: Value of Authorised Items
Number of Items Unauthorised: Value of Unauthorised Items
I Authorise the Replacement of the marked items (PRINT NAME) Signed:
