VOUCHER FOR REIMBURSEMENT BY DISTRICT 71 Date of Request: _____/____/_______ Phone number: ________________________ Cheque payable to: ______________________________ Full Name: _______________________________ Position held: _____________________ Home Address: _____________________________________________________________ Town/City_________________________________________________________________ County ______________________________ Country _____________________________ Post Code ___________________ Email ________________________________________ Reimbursement for Mileage incurred through agreed travel MUST make use of this voucher for payment.
1) Return this form by email or post to District Governor (addresses below) Reimbursement by the District should be made within 60 days after receipt of an authorized reimbursement request based on the availability of funds. Reimbursement claims should be made within 60 days of incurring the expense or by July 31 for expenses incurred in June.
2) The expenses will be reviewed for authorisation and categorisation. 3) The District Governor will forward this voucher to the Treasurer for payment. District Governor: Gary Sander DTM 2 Hockwold Road, Weeting, Suffolk IP27 0QE.
Email: gary.sander@d71.org
District Governors Approval: ___________________________________________ (Signature)
Information needed: Date, Function type (Club Officer Training, Area/Division Contest, Official Club visits, District Officer training), Venue address, mileage. Date of journey: _____/____/______ Function: _____________________________ Venue Address: ______________________________________________________ Mileage: ________________ Date of journey: _____/____/______ Function: _____________________________ Venue Address: ______________________________________________________ Mileage: ________________ Date of journey: _____/____/______ Function: _____________________________ Venue Address: ______________________________________________________ Mileage: ________________ Date of journey: _____/____/______ Function: _____________________________ Venue Address: ______________________________________________________ Mileage: ________________ Date of journey: _____/____/______ Function: _____________________________ Venue Address: ______________________________________________________ Mileage: ________________
Cheque number: ___________________________ Date mailed: ______________________________
Treasurers Signature: ________________________________