This form is used to calculate the mileage and fuel costs incurred by an employee during official duty. The distance covered is documented and verified in order to be able to reimburse the employee. The form is pretty simple and easy to fill out because of its clear cut format.
Company name: _______________________________
Company logo: ________________________________
Address: _____________________________________
Employee name: _______________________________
Employee ID no: _______________________________
Job title: ______________________________________
Department: ___________________________________
Tel: __________________________________________
Mobile: _______________________________________
Email: ________________________________________
Signature: _____________________________________
Expense authorized by: ___________________________
Department: ____________________________________
Signature: ______________________________________
Date mileage expense incurred:
From: __________________________________________
To: ____________________________________________
Description of vehicle used:
Make: __________________________________________
Vehicle registration: _______________________________
Please indicate details of mileage costs incurred:
Date:
________________________________________________
Starting mileage:
________________________________________________
Reason for traveling:
________________________________________________
Ending mileage:
________________________________________________
Cost of mileage expense:
________________________________________________
Date:
________________________________________________
Starting mileage:
________________________________________________
Reason for traveling:
________________________________________________
Ending mileage:
________________________________________________
Cost of mileage expense:
________________________________________________
Total amount of mileage cost in USD:
________________________________________________
Print This Post