| A | B | C | D | E | F | G | H | I | J | |
|---|---|---|---|---|---|---|---|---|---|---|
1 | SSF Travel Expense Claim | |||||||||
2 | http://wiki.sahanafoundation.org/doku.php/foundation:policies/travel | |||||||||
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4 | Date: | |||||||||
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6 | From: | To: | Sahana Software Foundation | |||||||
7 | Address: | 350 South Figeroa, Ste 437 | ||||||||
8 | City, State: | Los Angeles, CA 90071 | ||||||||
9 | Postal Code: | United States | ||||||||
10 | Province: | Tel 860-499-0332 | ||||||||
11 | Country: | www.sahanafoundation.org | ||||||||
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13 | Tel: | |||||||||
14 | E-mail: | |||||||||
15 | ||||||||||
16 | Origin: | |||||||||
17 | Destination: | |||||||||
18 | Purpose of Travel: | |||||||||
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20 | ||||||||||
21 | Date | Expense Type/Description | Cost (USD)* | Currency | Local Price | Currency | ||||
22 | USD | |||||||||
23 | USD | |||||||||
24 | USD | |||||||||
25 | USD | |||||||||
26 | USD | |||||||||
27 | USD | |||||||||
28 | TOTAL | $0.00 | USD | |||||||
29 | ||||||||||
30 | * Note: For foreign currency expenses, use http://www.xe.com/ict/ to convert to USD using the date matching the payment receipt. | |||||||||
31 | ||||||||||
32 | Payment Instructions | |||||||||
33 | Total Amount: | |||||||||
34 | Method (Paypal, Wire Transfer, Paper Check**): | |||||||||
35 | ||||||||||
36 | Paypal Instructions: | |||||||||
37 | E-mail address (Paypal): | |||||||||
38 | ||||||||||
39 | Wire Transfer Instructions: | |||||||||
40 | Full Bank Name: | |||||||||
41 | Full Address of the Bank: | |||||||||
42 | Telephone Number of the Bank: | |||||||||
43 | Contact Person (Name) at the Bank: | |||||||||
44 | Bank Routing Number (ABA or SWIFT): | |||||||||
45 | Other Bank ID (Specify): | |||||||||
46 | Name of Bank Account Number: | |||||||||
47 | Name of Account Holder: | |||||||||
48 | Currency to pay in: | |||||||||
49 | ||||||||||
50 | Paper Check Instructions**: | |||||||||
51 | Pay to: | |||||||||
52 | Address: | |||||||||
53 | City, State: | |||||||||
54 | Postal Code: | |||||||||
55 | ||||||||||
56 | ** US Only | |||||||||
57 | ||||||||||
58 | Instructions: | |||||||||
59 | 1. Complete all fields shaded in gray (if relevant) | |||||||||
60 | 2. If traveling more than one event that is coming from separate funding sources, please file a separate expense claim for each event, breaking down the costs between each event (including airfare, even if on a single itinerary/booking). | |||||||||
61 | 3. If you paid for something in a foreign (other than USD) currency – please look up the exchange rate on the date matching your receipt using http://www.xe.com/ict/ and provide USD value | |||||||||
62 | 4. Please select payment method – ideally provide information both for paypal and a bank wire transfer to allow SSF to chose least cost means of paying you. Please let us know of what incoming wire fees you you may be charged so we can take this into account in calculating the best payment method. | |||||||||
63 | 5. Note that our bank can pay in many foreign currencies and this usually results in the most favorable exchange rate for all parties and we will do this unless you specifically request to be paid in US Dollars and allow your bank to make the conversion. | |||||||||
64 | 6. E-mail completed Travel Expense claim to mark@sahanafoundation.org | |||||||||
65 | 7. Attach to that e-mail a scan (PDF), electronic receipt (e-mail) or digital photograph of all receipts | |||||||||
66 | 8. If part of your claim includes travel to multiple events for multiple purposes, or includes travel for personal reasons, please provide a documented breakdown of how certain expenses should be accounted for (particularly airfares). Ideally this would include documented quotes for different routings; if such quotes are not available, please provide a written and signed statement as to how such expenses should be claimed. | |||||||||
67 | 9. Please ensure that all expenses claimed fit within the provided expense authorization you received for the event attended and SSF travel policy | |||||||||
68 | ||||||||||