Employee Reimbursement Form

The reimbursement form is divided into five major segments: 1) Reimbursement Identification; 2) Listed Expenses; 3) Additional Commentary; 4) Signatures and; 5) Receipt Log.

1. Reimbursement Identification looks to gain a better understanding of who, what when and why the reimbursement is being requested.

• • Employee Name – Name of the person requesting for a reimbursement. For organizations that work with external reimbursements such as insurance companies, the word ‘employee’ can be changed to Reimbursee or Claimant.
  • Employee Contact – A way to reach out to the reimbursee for questions, concerns or to send the money transfer. It can be an e-mail or telephone number.
  • Employee ID – A unique identifier within the organization to help expedite the reimbursement process. External claimants may also have an ID depending on, for example, the insurance policy.
  • Manager Name – Supervisor involved in the reimbursee’s request. In some organization, it can be preferable to have the word Admin in place of Manager.
  • Manager Division – Segment of the organization where the manager is associated with.
  • Period From & To – Time in which the expenses were incurred.
  • Purpose – Short clarification of why the reimbursement is needed.

    2. Listed Expenses aims to itemize all the reimbursement items that have been requested by the reimbursee.

• • Date – The time when the expense was incurred. This helps the organization cross reference the receipts when an audit occurs.
  • Category – Classification in which the expenses fall under. For further management of reimbursement, organizations should strive to have a clear list of categories such as the ones provided in the excel version. E.g. Transportation, meal, dine, airfare, lodging, electronics, internet, entertainment, PPE, alcohol, cash-advance (should show as a negative amount), miscellaneous.
  • Description – A description of the type of expense that falls under the category provided in the listed item.
  • Amount – The total amount after tax incurred by said expense.
  • Total Reimbursement – Total amount of reimbursement requested based on the listed expenses.

     3. Additional Commentary is an opportunity to provide clarity with regards to the reimbursement. Whether it involves the purpose of the claim or a listed expense item, this is the place to answer.

    4. Signatures– Provides space for signature and date from both the reimbursee and the reimbursement approver within the organization. Some organizations may request to have the document downloaded and hand-signed while others may be comfortable with virtual signatures.

     5. Receipt Log – A page provided to allow the reimbursee to provide a copy or the original receipt. If digital copies are not accepted, please remove the wording within the file. Not all organizations have the means to process digitized receipts or signatures for that matter, therefore, it is important to consider one’s unique needs.