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UC STUDENT *Complete Certification Form. Non‐Travel BUSINESS MEAL (Complete Section C.)
NON‐UC STUDENT Non‐Travel ALL OTHER (Complete Section B.)
GUEST/VISITOR - Host Name: ______________________
Please type or legibly print THE UNIVERSITY OF CHICAGO
MATH DEPARTMENT REIMBURSEMENT FORM
PAYEE LAST NAME* FIRST NAME*
Please direct questions or return signed reimbursement forms
EMAIL ADDRESS* with receipts to:
MAILING ADDRESS* mathlbc@lists.uchicago.edu or Eckhart Hall 207B.
**Required for all
REIMBURSEMENT GUIDELINES
except GEMS users
1) All scanned receipts should be legible and facing the
A) TRAVEL Conversion Rate Used: same direction.
Destination City, State (or Country)*
2) The University may only reimburse reasonable and
Trip Start/End Dates* prudent business expenses. Travel receipts that show
additional guests/occupants (e.g. lodging, meals, cab fares)
B) TRAVEL or Non‐Travel ALL OTHER
typically require additional justification.
Business Purpose*
4) Payees should consult with the unit funding their
reimbursement to see if unit or funding source has more
restrictive requirements than University policy.
5) Original itemized receipts are required for:
a. Local or out‐of town business meals (meals where 2 or
more attendees meet specifically to discuss or conduct
university business) and hotel/lodging expenses regardless
of dollar amounts.
b. All expenses of $75 or more.
6) All expenses must be itemized whether or not a receipt is
required.
a. Description of the business purpose
Business Meal‐Complete C2 below b. Date of occurrence
TOTAL AMT CLAIMED* c. Amount of expense
If additional space is required, please itemize on a separate sheet and include total amount in 7) Lost receipts: Please contact vendor to request a copy of
box above. itemized bill for large expenses (e.g. hotel/lodging or car
C) ENTERTAINMENT/BUSINESS MEAL (Cannot be charged to Federal Grants.) rentals.) For smaller expenses, please provide an itemized
list (as noted in section 6), the receipt was lost, and that
1 ‐ AMOUNT CLAIMED* Receipt Amt:
payee will not be reimbursed by any other source.
(If different from Amt Claimed)
Visitor Name: (FOR INVITED GUESTS/SPEAKERS)
8) Car rentals: Do not purchase collision damage waiver
Host Name: (IF DIFFERENT FROM PAYEE) (CDW) or liability insurance coverage in the US or Canada,
but do purchase insurance coverage in a foreign country.
2 ‐ Please attach itemized dining check with receipt and list individual names if 10 or less attendees
Purpose of business meal*
For additional information on Procurement/Disbursements
Date of Event* # of attendees* university policies, please refer to Financial Policy 1200 at:
Name of other attendees (if 10 or less): http://finserv.uchicago.edu/support/policies/index.shtml
To report all University business related travel accidents,
call the Risk Management Department at 773‐702‐1951 as
soon as possible. If a rented vehicle is damaged, refer the
rental agency to the Risk Management Department.
I certify that the amounts listed above are my true business expenses, that they have not and
will not be reimbursed by another entity, and are in accordance with current University of FUNDING UNIT APPROVAL
Chicago reimbursement policies and procedures.
Account to charge: