Claim for Travel Expense

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					                                                    CLAIM FOR TRAVEL EXPENSE
             All documents must be printed or typed clearly. Traveler's signature and authorization signature are required.
TRAVER'S PERSONAL INFORMATION
Name:                                                                      Email:
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:


Trip Destination:
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.
TRANSPORTATION
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:
                                                                                              Ship Fares:
Registration Fees:                                          Was Reg. Fee paid by another source?
Taxi:                              Purpose:
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
DATE:
Breakfast:
Lunch:
Dinner:
Incidentals:
Total Exp.:   -              -            -         -        -       -         -         -            -        -         -        -            -
LODGING EXPENSES                   Please itemize lodging expenses
Per night:
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:




         Rev.9/20/2001