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Reimbursement Request Form
This form is for payment and reimbursement request. Please note for all reimbursement request, the original receipt needs to be submitted to your department lead before reimbursement will be approved.
Type of Request
Requested by:
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Ministry
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Address:
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Phone Number:
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Email:
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Date Needed:
MM
/
DD
/
YYYY
1. Reason for Request/description of event 2. Expense Type 3. Details of Expenditure
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Vendor Name or Payee
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Amount:
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