Annual Expense Form

Please fill out the form with your information below.

General Information

Name of Individual

Position/Department

Reporting Date

Expense Details

Date	Expense Type	Description of Expense	Amount	Receipt Attached (Yes/No)

Total Expense Summary

Total Amount of Expenses

Advance Paid

Balance Due/Refund

Declaration

I hereby certify that the expenses listed above are accurate, incurred for legitimate business purposes, and comply with the company’s expense policy.

Date:

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