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STUDENT & VISITOR REIMBURSEMENT CLAIM FORM

This form is to be used by students, Visitors & Conjoints only. Staff now claim reimbursements through the Spendvision expense management system.

Spendvision user documentation can be found at: http://www.newcastle.edu.au/service/purchasing/spendvision.html

PLEASE COMPLETE ON SCREEN Sections a/b/c/d/e if applicable
Please attach ORIGINAL Receipts              Print form & forward to Payments , student services building.

Title

Given Names
Family Name
Please choose one:

Student Student No.
Conjoint  Staff No.

Visitor Do you have a Creditor Code? Y N If yes - code:
  If no, please complete a Creditor Code request after reading instructions
 
Faculty/School/Division: Phone:
Destination/City Date of Travel
Student/Visitor Address
City State Postcode
Payment via EFT method only - No Cheques will be issued
Student/Visitor
EFT Details Required		 Bank Code    BSB No. Account No. O/S Swift Code
-  
Email Address  
Ledger Code - PR = Project (PXXX-XXXX-XXXX), GL = General (XXX-XXXX-XXXX)
SECTION A
DOMESTIC TRAVEL
ORIGINAL TAX INVOICES/RECEIPTS/SUPPORTING DOCUMENTATION TO BE ATTACHED
Contact your Financial Services Manager if you are unsure of account numbers or GST Rate Codes or refer to the Taxation Policy at http://www.newcastle.edu.au/services/taxation/index.html
 
Ldg Code
Cost Centre
Account Code
GST Code
Amount
I / E
Student/
Visitor
/ /
$
 
/ /
$
 
/ /
$
 
/ /
$
Details
TOTAL SECTION A
$
SECTION B
REIMBURSEMENT FOR USE OF PRIVATE MOTOR VEHICLE
Reg No:
Engine Capacity: cc
kms@ ¢/Km
Ldg Code
Cost Centre
Account Code
GST Code
Student/
Visitor
/ /
P
/ /
P
/ /
P
/ /
P
Details
 
TOTAL SECTION B
$
SECTION C
INTERNATIONAL TRAVEL
Actual Expenses to be claimed
FOR OUT OF POCKET EXPENSES ATTACH ORIGINAL RECEIPTS AND SUMMARY OF EXPENSES
Click on this link for Foreign Currency Exchange Rates - http://www.oanda.com/converter/classic
Amount
 
Ldg Code
Cost Centre
Account Code
GST Code
Student/
Visitor
/ /
Z
$
 
/ /
Z
$
/ /
Z
$
 
/ /
Z
$
Details
TOTAL SECTION C
$
SECTION D
OTHER REIMBURSMENTS
ORIGINAL TAX INVOICES/RECEIPTS/SUPPORTING DOCUMENTATION TO BE ATTACHED
 
Ldg Code
Cost Centre
Account Code
GST Code
Amount
I / E
Student/
Visitor
/ /
$
Details
 
/ /
$
Details
 
/ /
$
Details
 
/ /
$
Details
TOTAL SECTION D
$
TOTAL OF CLAIM = A + B + C + D
$
I certify, in terms of Section 12 (2) and (3) of the Public Finance and Audit Act 1983 as amended, that the above travel was for University purposes only and that the claim as set out above is correct in every detail.
Authorised Travel Completed   Y N
Claimant Claim Approved

Name: ………………………………………………..
Name: ……………………………………………………..

………………………………………………………………./…../…..
……………………………………………………………………../…../…..
Signature of Claimant Signature: Head of Faculty/School or Delegated Officer
REQUIREMENTS / INFORMATION RE TAXATION
1. PRIVATE VEHICLE USE WITHIN AUSTRALIA
Where the University reimburses private vehicle use on a kilometer basis, such reimbursements will be recorded on group certificates.
2. INTERNATIONAL TRAVEL IN EXCESS OF 5 NIGHTS WHERE EXPENSES ARE PAID DIRECT BY THE UNIVERSITY OR REIMBURSED
You must complete BOTH the following Expense Payment Benefit Declaration and Travel Diary. Payments will not be recorded on group certificates.

EXPENSE PAYMENT BENEFIT DECLARATION
(Only required where Travel Diary is required i.e. for International Travel exceeding 5 nights)

I …………………………………………………….. declare that expenses detailed on the reverse side of this form were incurred by me on the dates and for the purpose stated on the relevant Spendvision Pre-Approval Requisition.

I also declare that the percentage of those expenses incurred in earning my assessable income was 100%. (Please indicate if less than 100% …….)

Signature ……………….……………………………………………………………………. Date ……….…../……….…../……..…….
TRAVEL DIARY
(Only required for international travel exceeding 5 nights)
PLACE
BRIEF DESCRIPTION OF ACTIVITY
DATE COMMENCED
DATE COMPLETED
NB: If more lines are needed please attach a separate list.
Employees are advised that they should maintain their
own records to enable substantiation of all expenditure
as may be required by the Australian Taxation Office in
respect of their personal income tax returns.
Name: …………………………………………………………………

Signature …………………………..…….Date ….…./.……./…….


Last Updated 24/04/07