FSLDW Expense Form

Name*

First Last

Address*

Street Address Address Line 2 City Province Postal Code

Email*

Phone*

Pastoral Charge/Community of Faith Represented

Name of Other Ministry*

Meeting/Event*

Please specify Other*

Name of Staff Person or Division/Committee Chair*

Date of Meeting/Event*

Expense Policies

Expenses will only be reimbursed for those items for which receipts are provided except for mileage and tolls/bridge.
Use of private vehicle is $0.30/kms.
Standard meal allowance breakfast up to $7, lunch up to $8, dinner up to $15 (receipts required). Please note that the cost of alcoholic beverages cannot be claimed.
If requesting single accommodations please deduct $45/night from your accommodations total (receipts required).

Destination From

Destination To

Enter the number of kms driven

Calculated Mileage Expense (Receipts not required)

@ $0.30 per kms

Accommodations (Receipts Attached)

If requested single accommodations please deduct $45/night from your total accommodations cost.

Meals (Receipts Attached)

Breakfast up to $10.00 / Lunch up to $15.00 / Dinner up to $25.00

Air Fare / Bus / Taxi (Receipts Attached)

Bridge / Toll (Receipts Not Required)

Bridge / Toll Expense Details

Other Expense (Receipts Attached)

Please detail other expenses.

Total Calculated

The submitted expense form will be reviewed by the committee chair or support staff person.

File Upload of Receipts

Drop files here or

Max. file size: 64 MB.

Comments (purpose of expense)*

Voluntary Donation

This option is provided in response to requests from members. It is entirely voluntary. If you would like to donate all or a portion of your expense reimbursement to the Fundy St. Lawrence Dawning Waters Regional Council, please complete the below section of the form. The amount you specify will be deducted from your reimbursement and you will receive a charitable donation receipt by the end of February the year following your donation.

Enter Gift Amount

I direct that the below amount of the funds to which I am entitled by way of this reimbursement as outlined above, and would otherwise be forwarded to me, be donated to support the Fundy St. Lawrence Dawning Waters Regional Council as a gift. The usage of the donated funds will be determined by the Financial Accountability and Investments Committee each year as per the needs of the Region. A charitable donation receipt will be issued for this donation. Thank you!

Signature

First Last

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Approval

Following approval, the name field below can be completed by an admin

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Approved by

Finance Chair

First Last

Phone

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Voluntary Donation

Approval

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