Preview Expense Reimbursement Form

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

HTML Preview Expense Reimbursement Form page number 1.