CLAIM FOR TRAVEL EXPENSE
All documents must be printed or typed clearly. Traveler's signature and authorization signature are required.
TRAVER'S PERSONAL INFORMATION
Home PH# Work PH#
City of Residence *US Citizen/Permanent Resident: Y/N
*Non UC Berkeley Employee Must Provide Home Address UC Berkeley Employee: Y/N
UC Berkeley Employee Number:
Social Security Number:
All Non US citizens if Non UCB Employees must attach a copy of their visa, I-94 and fill out a statement of citizenship form.
Purpose of trip:
Name of project to be charged:
Date of Leave: Departure Time: Arrival Time:
Date of Return: Departure Time: Arrival Time:
For multiple destinations on please indicate arrival and departure times and destinations for each leg of your trip. This can be added to a
separate sheet of paper if needed and attached to this form.
Private car mileage (¢40.5/mile) Between what points:
Mileage: License Plate: Insurance Liability: Y/N
UC Employee Passengers:
Airfare: Ticket Charged to CEDR by CTS: Y/N Travel Advance: Y/N
Comments about airfare: Parking Fees:
Registration Fees: Was Reg. Fee paid by another source?
Buses: Rail Fares: Limousines:
Rental Car: Bridge Tolls:
Justification for use of Rental Car: personal car unavailble
Other Business Expenses:
MEAL EXPENSES (Please Note if meal expenses were covered by conference etc.)
For domestic travel an itemized list of meal expenses is required. Use separate sheet for additional info.
Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Day10 Day 11 Day 12 Day 13
Total Exp.: - - - - - - - - - - - - -
LODGING EXPENSES Please itemize lodging expenses
Phone calls Please note on the bills if they are business or personal (you are allowed 1 personal phone call home per day).
Phones: Internet Access: Other:
Conference Hotel: Y/N Was the conference held in a specific hotel organized by the sponsor? Y/N
Foreign Travel (If claiming per diem indicate how many days and hours claiming in each destination).
Internal Use: To be completed by Grants Administrator Business Unit 1
Account Fund Org Prg Project Flexfield Speedtype Amount
The above is a true statement of travel expense incurred by me on official University business on the dates shown.
Traveler’s Signature: Date:
Grants Administrator Approval: Date: TOTAL:
PI Approval: Date: