Expense Statement - RRFC
Expense Statement - RRFC
Expense Statement - RRFC
Name:
Rafiq Ahmed Siddique
Rotarian/Staff/Officer
Rotarian
:
Staff Liaison:
Rotary ID:
Address:
Country:
E-mail:
Bangladesh
Payment Option:
RI Exchange Rates
Date
24-Nov-16
28-Nov-16
5-Dec-16
24-Nov-16
25-Nov-16
26-Nov-16
27-Nov-16
27-Nov-16
27-Nov-16
28-Nov-16
29-Nov-16
30-Nov-16
1-Dec-16
2-Dec-16
3-Dec-16
4-Dec-16
Expense
Type
Payee Form
Payment Guidelines
Spouse Form
Contribution Form
Description/
Business Purpose of Expense
Others Present
(Business Relationship & Number)
Airfare
Dhaka - Karachi
Airfare
Karachi - Bangkok
Airfare
Bangkok - Dhaka
Lodging
Lodging
Lodging
Lodging
Transportation
Lodging
Lodging
Lodging
Lodging
Lodging
Lodging
Lodging
Lodging
28-Nov-16
Transportation
Airport to Hotel
28-Nov-16
29-Nov-16
1-Dec-16
3-Dec-16
4-Dec-16
Meals
Room Service
Meals
Lobby Lounge
Meals
Lobby Lounge
Meals
REDSKY
Transportation
Hotel to Airport
5,373.40
Date(s) Cover
Vendor # - Location:
Title/Office:
RRFC, 2014-2017
Location of
Assignment:
Zone 6B
Assignment:
RRFC, 2014-2017
Currency:
5,373.40
Exch Rate:
Signature:
Guidelines for Submitting Expense Statement
Guidelines for Using RI Exchange Rates
Amount of
Expense (in local
currency)
Currency
US$
Total
Exchange Rate
540251
23.88
26.23
22.19
206.14
71.43
Not Req
Not Req
Not Req
Required
Not Req
540251
540251
540251
540251
540251
2,400.00
THB
35.00000000
835.67
918.06
776.82
7,215.01
2,500.00
THB
THB
THB
THB
THB
35.00000000
35.00000000
35.00000000
35.00000000
Director/Staff Contact
Approval:
* Date:
Acct
Not Req
2,417.72
430.48
430.48
430.48
225.03
15.09
125.71
125.71
125.71
125.71
125.71
125.71
125.71
125.71
Documentation
68.57
79.00000000
105.00000000
105.00000000
105.00000000
105.00000000
105.00000000
35.00000000
35.00000000
35.00000000
35.00000000
35.00000000
35.00000000
35.00000000
35.00000000
35.00000000
TOTAL (Local Curr)
Out. Adv.
60 Day
Dup. Pmt.
Spouse Form (if app.)
Proof of Pmt
Business Purpose Totals
Required
Required
Required
Required
Required
Not Req
Required
Required
Required
Required
Required
Required
Required
Required
BDT
PKR
PKR
PKR
PKR
PKR
THB
THB
THB
THB
THB
THB
THB
THB
401,657.86
540201
540201
540201
540251
540251
540251
540251
540251
540251
540251
540251
540251
540251
540251
540251
540251
191,000.00
45,200.00
45,200.00
45,200.00
23,628.30
1,584.00
4,400.00
4,400.00
4,400.00
4,400.00
4,400.00
4,400.00
4,400.00
4,400.00
$
Department (Cost Center)
Approval:
5,373.40
TOTAL US$
* Date:
Disclaimer
*By signing this document, I confirm the accuracy of all calculations and that appropriate documentation (i.e., receipts or proof of payment) has been submitted and is in compliance with Rotary expense reimbursement guidelines.
Documentation is required for any expense equal to or over US$75 (Rotarian)** / US$25 (staff)** and for all lodging expenses.
Expense statements must be submitted within 60 days (Rotarian) / 30 days (staff) of the date on which the expenses were incurred to be eligible for reimbursement.
For air travel, the unused portion or receipt portion of the ticket (and copy of authorization if purchased by source other than RITS) must be attached in order to process this request.
If you have questions about completing this expense statement, click the tab labeled "Instructions" below.
** Note: If your countrys regulations for documentation of expenses are more strict than the Rotary guidelines, please follow those regulations when providing receipts with your expense statement
Revised Aug 10
Page 1
Country:
E-mail:
Date
2588663
SIDDIQUES' Apt. # A-1, House # 13,
Road
# 7 Dhaka -1212.
Gulshan-1,
Bangladesh
Payment Option:
Expense
Type
Description/
Business Purpose of Expense
5,373.40
Title/Office:
RRFC, 2014-2017
Location of
Assignment:
Zone 6B
Assignment:
RRFC, 2014-2017
5,373.40
Signature:
Amount of
Expense (in local
currency)
Others Present
(Business Relationship & Number)
401,657.86
Currency
US$
Total
Exchange Rate
5,373.40
Documentation
TOTAL US$
Disclaimer
*By signing this document, I confirm the accuracy of all calculations and that appropriate documentation (i.e., receipts or proof of payment) has been submitted and is in compliance with Rotary expense reimbursement guidelines.
Documentation is required for any expense equal to or over US$75 (Rotarian)** / US$25 (staff)** and for all lodging expenses.
Expense statements must be submitted within 60 days (Rotarian) / 30 days (staff) of the date on which the expenses were incurred to be eligible for reimbursement.
For air travel, the unused portion or receipt portion of the ticket (and copy of authorization if purchased by source other than RITS) must be attached in order to process this request.
If you have questions about completing this expense statement, click the tab labeled "Instructions" below.
Revised Aug 10
Page 2
Country:
E-mail:
Date
2588663
SIDDIQUES' Apt. # A-1, House # 13,
Road
# 7 Dhaka -1212.
Gulshan-1,
Bangladesh
Payment Option:
Expense
Type
Description/
Business Purpose of Expense
5,373.40
Title/Office:
RRFC, 2014-2017
Location of
Assignment:
Zone 6B
Assignment:
RRFC, 2014-2017
5,373.40
Signature:
Amount of
Expense (in local
currency)
Others Present
(Business Relationship & Number)
401,657.86
Currency
US$
Total
Exchange Rate
5,373.40
Documentation
TOTAL US$
Disclaimer
*By signing this document, I confirm the accuracy of all calculations and that appropriate documentation (i.e., receipts or proof of payment) has been submitted and is in compliance with Rotary expense reimbursement guidelines.
Documentation is required for any expense equal to or over US$75 (Rotarian)** / US$25 (staff)** and for all lodging expenses.
Expense statements must be submitted within 60 days (Rotarian) / 30 days (staff) of the date on which the expenses were incurred to be eligible for reimbursement.
For air travel, the unused portion or receipt portion of the ticket (and copy of authorization if purchased by source other than RITS) must be attached in order to process this request.
If you have questions about completing this expense statement, click the tab labeled "Instructions" below.
Revised Aug 10
Page 3
Country:
E-mail:
Date
2588663
SIDDIQUES' Apt. # A-1, House # 13,
Road
# 7 Dhaka -1212.
Gulshan-1,
Bangladesh
Payment Option:
Expense
Type
Description/
Business Purpose of Expense
5,373.40
Title/Office:
RRFC, 2014-2017
Location of
Assignment:
Zone 6B
Assignment:
RRFC, 2014-2017
5,373.40
Signature:
Amount of
Expense (in local
currency)
Others Present
(Business Relationship & Number)
401,657.86
Currency
US$
Total
Exchange Rate
5,373.40
Documentation
TOTAL US$
Disclaimer
*By signing this document, I confirm the accuracy of all calculations and that appropriate documentation (i.e., receipts or proof of payment) has been submitted and is in compliance with Rotary expense reimbursement guidelines.
Documentation is required for any expense equal to or over US$75 (Rotarian)** / US$25 (staff)** and for all lodging expenses.
Expense statements must be submitted within 60 days (Rotarian) / 30 days (staff) of the date on which the expenses were incurred to be eligible for reimbursement.
For air travel, the unused portion or receipt portion of the ticket (and copy of authorization if purchased by source other than RITS) must be attached in order to process this request.
If you have questions about completing this expense statement, click the tab labeled "Instructions" below.
** Note: If your countrys regulations for documentation of expenses are more strict than the Rotary guidelines, please follow those regulations when providing receipts with your expense statement
Revised Aug 10
Page 4
Revised July 09
US$ Total
Documentation
Grand Total
Total US$
NOTE: If your expenses exceed the number of rows available on the first page, please click the link at the bottom to complete more rows of expenses.
Clicking this link will bring you to an additional expense statement worksheet.
Final Steps:
Once you've completed the expense statement, please review for accuracy, sign/date, print, and forward to the appropriate staff liaison/manager for approval.
Note: By signing this expense statement, the requestor is attesting that all items are reasonable and necessary business-related expenses incurred while conducting
authorized Rotary business.
Revised July 09