EXPENSE RECORD

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IHTSDO Staff Travel Expense Record The IHTSDO Travel Policy governs authorization and reimbursement of expenses (e.g. requirements for receipts and approvals). Name: Destination: # Personal Days: Event: Signature: Date Left (dd-mm-yy): Date Returned: Date Submitted: Location: Activities: Time: Time: Page 1 Exchange Rate Other Currency 1 (e.g. USD): Other Currency 2: Reimburse in (e.g. DKK): per 100 : per 100 : Danish rates Per Diem (max 455 DKK) in 0 Transport Expenses (under DKK 25 included as part of incidentals) From Dep. Date To Ret. Date Type Cost() Cost() Cost() 0.00 0.00 0.00 0.00 0.00 TOTAL #1 Per Diem Category Breakfast Lunch Dinner Incidentals (only if overnight) % of total 15% 30% 30% 25% 00/01/00 01/01/00 02/01/00 03/01/00 04/01/00 05/01/00 # eligible days TOTAL #2 0 0 0 0 0.00 0.00 0.00 0.00 0.00 Card (Y/N)? Other Eligible Expenses (excluding per diem) Expense (e.g. Hotel) Date(s) Cost() Cost() Cost() 0.00 0.00 0.00 0.00 0.00 0.00 Card (Y/N)? TOTAL #3 Personal Expenses Charged to IHTSDO Credit Card (e.g. Meals, misc. expenses of less than 25 DKK) Billed by (e.g. Restaurant name) Date(s) Cost() Cost() Cost() 0.00 0.00 0.00 0.00 0.00 Summary Total Eligible Expenses (totals 1-3) in Work (Eligible) Expenses charged to IHTSDO credit card in Personal expenses charged to IHTSDO credit card in Travel advance received (if any) in Balance Due to Me in 0.00 0.00 0.00 0.00 0.00 IHTSDO Staff Travel Expense Record The IHTSDO Travel Policy governs authorization and reimbursement of expenses (e.g. requirements for receipts and approvals). Name: Destination: Event: 0 Date Departed: 0 Date Returned: 0 Location: 1/0/1900 1/0/1900 Page 2 0 CPH Office Staff (Y/N)? Pre-Submission Check List Other Staff (Y/N)? MB (Y/N)? Flight/train itinerary information included Boarding passes included Receipts included with claim and stapled onto blank paper for secure processing and easy copying All items charged to IHTSDO credit card marked with coloured dot (sticker) Appropriate currency exchange rates used (see travel policy) Incidentals per diem only claimed for overnight stays (not for day trips or if on the plane overnight) Written permission of CEO included for any hospitality claims (e.g. payment of meal during meeting with Member) Local transport in private vehicles calculated in kilometers not miles (1.6km=1 mile) Rates are DKK 3.47 up to 20 000 km and DKK 1.83 for longer journeys If Reimbursement Due: Please transfer into the same account as my salary is deposited to Please transfer to another account Account holder name: Account holder address: IBAN number: SWIFT/BIC number: Bank address: Will these expenses be partly or fully reimbursed by another organization or will an honorarium be paid? No Yes (please describe) For IHTSDO Office and Accounting Use Only This travel reimbursement request complies with IHTSDO policies (note any exceptions) and approval is recommended Business Manager (or delegate) signature: This travel reimbursement request is approved: CEO/MB Chair signature: These expenses should be charged as follows: Account 11410 11420 11430 11440 11450 11455 Amount 0 0 0 0 0 0 Date: Date: IHTSDO Travel Reimbursement Form - Travel is contingent on IHTSDO authorization

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