Guest Traveler Certification Of Expenses - Free Download
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Expense reimbursement claim for the amount of $___________
Payable to __________________________________________
I certify that the expenses were incurred by me while on official University business on the dates
shown, and that no expenses claimed as reimbursable relate to personal or unallowable
expenses. I also certify that I did not receive reimbursement from any other source(s) for the
expenses claimed. In the event of an overpayment, or if payment is received from another
source for any portion of the expenses claimed, I assume responsibility for repaying UC Regents
in full for those expenses.
To be completed only if UCSF employee is signing on behalf of the guest. All fields required.
Complete the form, print, obtain guest signature or complete and sign on behalf of the guest. Scan
and attach completed and signed form to the Expense Report. See the job aid Creating an
Expense Report for a Non-Employee in MyExpense for more information.
Revised October 2015
Travel & Entertainment
Guest Traveler Certification of Expenses Form
This form is a required attachment for all Guest Policy Expense Reports created in MyExpense.
The completed and signed form must be attached before the Expense Report is submitted.