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Get Signature Of Claimant Form

Visitor Claimant Signature Form Request for Expense Reimbursement This form is to be used to obtain the signature of University visitors who have departed prior to their electronic expense report being processed. Along with the original receipts this form must be signed and attached to the official printed expense report. The following banking information is required to ensure successful transmission. IBAN Bank SWIFT/ABA RT if any Bank Name Bank Address Beneficiary Bank Account Number Name of Bank Account Holder I certify that all expenses submitted are accurate and in accordance with University policy and will not be used for income tax purposes. I certify that all expenses paid by the University or by any other party have been deducted. I agree to refund to the University any subsequent reimbursements from other organizations for the expenses submitted. Claimant s Signature Revised 2009-02-09 Date. Use of this form is not permitted for McGill employees. I authorize to submit print visitor s name print person s name the following expenses on my behalf* Attached are my receipts for Purpose related to the expenses Expenses were incurred from to DD-MM-YY Amount of original receipt s attached CAD USD Other Estimated expense s to be incurred following departure CAD USD Other state nature i*e* taxi meal Total estimated request for reimbursement in CAD To be completed by Requestor at time of expense report submission True value of total estimated request for reimbursement CAD Claimant s Mailing Address provide complete address Address City State/Province Postal/Zip Code Country Reimbursement to be issued in choose one CAD USD Other specify All reimbursements in other currencies will be made by wire transfer. The following banking information is required to ensure successful transmission* IBAN Bank SWIFT/ABA RT if any Bank Name Bank Address Beneficiary Bank Account Number Name of Bank Account Holder I certify that all expenses submitted are accurate and in accordance with University policy and will not be used for income tax purposes. I certify that all expenses paid by the University or by any other party have been deducted* I agree to refund to the University any subsequent reimbursements from other organizations for the expenses submitted* Claimant s Signature Revised 2009-02-09 Date. Use of this form is not permitted for McGill employees. I authorize to submit print visitor s name print person s name the following expenses on my behalf* Attached are my receipts for Purpose related to the expenses Expenses were incurred from to DD-MM-YY Amount of original receipt s attached CAD USD Other Estimated expense s to be incurred following departure CAD USD Other state nature i*e* taxi meal Total estimated request for reimbursement in CAD To be completed by Requestor at time of expense report submission True value of total estimated request for reimbursement CAD Claimant s Mailing Address provide complete address Address City State/Province Postal/Zip Code Country Reimbursement to be issued in choose one CAD USD Other specify All reimbursements in other currencies will be made by wire transfer. The following banking information is required to ensure successful transmission* IBAN Bank SWIFT/ABA RT if any Bank Name Bank Address Beneficiary Bank Account Number Name of Bank Account Holder I certify that all expenses submitted are accurate and in accordance with University policy and will not be used for income tax purposes.

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