HTML Preview Expense Reimbursement Form page number 1.


First Name Vendor / Uni ID
Phone
Related Travel Request ID
Staff
Student
Person of Interest / Visitor / Other
Receipt
#
Total AUD incl GST
FBT
Applies
BSB Account Number
Name of Bank Account Name
Signature Date
Uni ID Job Title
Signat
ure Date
Part D: DECLARATION
Part E: DELEGATE APPROVAL
Bank Street Address
IBAN
TOTAL AMOUNT AUD
Pay group (select one)
Description of Item Purchased
EXPENSE REIMBURSEMENT FORM
Non-ANU address
Business Unit
Family Name
Send completed form to [email protected]
Finance & Business Services, Bldg 10c
Enquiries: (02) 6125 4777
Former Students & Visitors: MUST provide your current bank account information below. Current Staff & Students should log onto HORUS / ISIS to update their account details.
Part A: PERSONAL PARTICULARS
Part B: EXPENSES - Invoices (Tax or overseas) MUST be attached to verify ALL claims
Part C: BANK DETAILS
I acknowledge I have read the instructions relating to reimbursements and that the above costs were incurred by me in accordance
with ANU Policies and I have attached relevant supporting documents
Additional information required for foreign bank
accounts
SWIFT/BIC CODE
Name of Delegate
Charge Code
(It is the responsibility of the Delegate to ensure they have Financial Delegation ID 220 and the appropriate limit.)
$ 0.00
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