DIVISIONOF UNIVERSITY OPERATIONS FINANCE AND PROCUREMENT SERVICES

This form is maintained on the Finance & Procurement Services website. If this form has been downloaded or printed, it may not be the current official version.

Coversheet for Receipts Supporting Credit Card Transactions / Expense Reimbursements Edited Mar 2017

Purpose of Form

This form is to be completed for staff who have been provided with a UniversityCorporate Credit Card:

  • to enable the purchases to be acquitted; or
  • when personal fundsare used for authorised business expenses, requiringreimbursement by the Expense Management Team.

If any of the expenses below have been incurred for private purposes, please check the Private Expense box; a bill will be issued to you to recover these funds. Once completed, email to Finance and Procurement Services at .

Is / are the items listed below regarding ☐Card Transaction(s) OR ☐ Expense Reimbursement (check as appropriate)

If your expense reimbursement is to be approved by the Expense Management Team an authorising signature (below) will need to be gained from your line manager.

CARD HOLDERDETAILS
Employee ID / Card HolderName
Faculty / Division
School/ Branch
DETAILS OF RECEIPTS
Date / Supplier / Reason for Expense / Private Expense / Project Code / Amount
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FRINGE BENEFITS TAX – EXPENSE DECLARATION PAYMENT BENEFIT – UOA EMPLOYEES ONLY
  • In accordance with the Fringe Benefits Tax Assessment Act (1986) requirements set out by the Australian Tax Office, I declare that these expenses were incurred by me in respect of my, ______(print name) employment at The University of Adelaide during the period______(insert date range)

Reason for Expense
The expenses within this form were incurred for the following purposes (provide sufficient information to demonstrate the extent to which the expenses were incurred by you for the purpose of earning your assessable income).
If the expense relate to meals / entertainment, please attach a list of attendees for FBT purposes.
Percentage
I also declare that the business percentage of those expenses which were incurred in earning my assessable income was _____%
DECLARATIONAUTHORISATION (APPLICANT)
  • I declare that the above expenses wereincurred by me for valid University business purposes and in accordance with the Travel & Entertainment Policy and Procedures
  • Where I have indicated PRIVATE, I understand I will be sent an invoice for this amount.
  • In the absence of a tax invoice, I acknowledge that the University will not be able to claim a refund for any GST paid and that my School / Branch will be charged for the full amount of these transactions. Submit lost receipt form

Applicant’s Signature / Line Manager Signature (if necessary)
Print Name
Date / Date

For further support or questions, please contact or extension x33330

This form is maintained on the Finance & Procurement Services website. If this form has been downloaded or printed, it may not be the current official version.