12 Expense Allocation (please group expenses by coding) Fund (5) Org (5) Acct (4) Actv (6) Locn (6) Base GST Exempt 1 Total reimbursement and total allocated must be equal 2 3 4 Who to contact about this claim: Contact Name Phone Email Dept Total Allocated (B) 0.00 (A)-(B) must equal 0.00 0.00 Is currency conversion required If "yes" specify: Currencies other than CAD/USD will be paid by wire, attach International Payment Information Form Claimant s One over One Approver Signature Approver s V Claimant s Signature (or attach declaration) Date (dd-mmm-yy) Account Holder s Signature (Delegate) Printed Name Printed Name Title I attest that the expenses claimed are original and I certify that I have reviewed this claim and find it to be reasonable I authorize these expenses to be charged to the legitimate incurred on authorized UVic business and have account(s) noted and that sufficient budget exists..
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