Accountable Professional Expense Fund
Claim Form
Instructions:
1) This is to be used for reimbursements from the various Accountable Professional Expenses Account such as the Faculty, ASPA, Exempt group, etc 2) Attach ORIGINAL supporting documentation for expenditure 3) Ensure all required fields are completed 4) For re-imbursements to staff - allow 10 working days for cheque creation 5) Forward completed form to: Payment Services, Room E80, Administration Building ________________________________________ Phone: ______________ Employee ID: _____________
Department :
Employee Name: ________________________________________ UniFi Vendor Number: ______________________
Campus address: ________________________________________________________ Indicate the type of Professional Development Fund Individual Accountable Professional Development Fund Dean, Senior Admin or Department Head Accountable Expense Fund Required Coding
Chrt (1) Fund (6) Orgn (4) Acct (5) Prgm (4)
Optional coding
Acty (5) Lctn (6) AMOUNT
Internal use only
TOTAL Additional Information:
I HEREBY CERTIFY THAT: The above expenses were incurred for my professional, teaching and/or research activities. Any personal benefit is incidental to the above charges. The expenses have not and will not be claimed from any other source. Title of Ownership of any goods shall remain with the University of Saskatchewan. These expenditures will not be deducted on my personal income tax return. I understand if the actual use is different than that noted above, the personal benefit will be a matter between myself and Canada Revenue Agency. I have reviewed the guidelines related to the administration of these funds. Requested by : Approved by : Print Name: Date: Date: _____________ _____________