Payment Reimbursement Notice Format Template
Share
Payment Reimbursement Notice Format
Your Company Name
Company Address
City, State, ZIP Code
Phone Number
Email Address
Date: Insert Date
Reimburser’s Information:
Name: Insert Reimburser’s Name
Position/Title: Insert Position/Title
Company Name: Insert Company Name
Contact Information: Insert Phone Number / Email
Recipient’s Information (Claimant):
Name: Insert Claimant’s Name
Position/Title: Insert Position/Title
Company Name: Insert Company Name (if applicable)
Contact Information: Insert Phone Number / Email
Details of Expenses Incurred
Expense Description | Date Incurred | Amount | Reason for Reimbursement |
|---|---|---|---|
Description of Expense | Insert Date | Insert Amount | Brief Explanation |
Description of Expense | Insert Date | Insert Amount | Brief Explanation |
Total Reimbursement | Total Amount |
Supporting Documentation
Please find attached the following documents for your reference:
Receipt/Invoice #1
Receipt/Invoice #2
Other Relevant Documents
Authorization
By signing below, the reimbursement claim is approved for payment, subject to any necessary adjustments based on company policies.
Authorized By:
Name: Authorized Signatory Name
Position: Authorized Signatory Position
Signature: _______________________
Date: ________________________
Instructions/Notes:
Please submit all claims within the Insert time frame, e.g., 30 days.
Ensure all receipts or proof of purchase are attached to avoid delays.
If you have any questions, please contact Contact Person’s Name at Contact Person’s Email/Phone.
Templates
Notice
Templates
