US 9/1/07 011,4-5,99 (Page 1)

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HARVARD UNIVERSITY MISSING RECEIPT AFFIDAVIT Please read the Missing Receipt Affidavit requirements on the back of this form. Missing Receipt Affidavits lacking
the required information or documentation will be returned to the authorized signer. Airline Ticket Receipts Attached is a copy or fax of the airline ticket receipt (last page of the ticket stub). - OR - I certify that I have contacted the agency and was unable to obtain a copy of the ticket receipt. Therefore I have
attached one of the following: A copy of the GE Corporate Mastercard statement
A copy of the itinerary invoice and form of payment (i.e., credit card statement, cancelled check) Hotel Folio Attached is a copy or fax of the hotel folio. - OR - I certify that I have contacted the hotel and was unable to obtain a copy of the hotel folio. Please reimburse me
based on the following information: Dates Hotel/City # of Nights Daily Rate * Total *Daily rate excluding taxes and service charges. Car Rental Agreement Attached is a copy or fax of the car rental agreement. - OR - I certify that I have contacted the rental car agency and was unable to obtain a copy of the car rental agreement.
Please reimburse me based on the following information: Dates Rental Company Car Class * # of Days Total *C=Compact, M=Mid-size, F=Full-size Meals (list each meal separately) Date B, L, D * Restaurant/City # of People Total *B=Breakfast, L=Lunch, D=Dinner (Note: if more than 1 person, please include business purpose on Expense Report or PCard Settlement System.) Miscellaneous Attached is a copy of the PCard statement. Date Description (in detail) Total I, the undersigned, certify (a) that each expense described above, reported on expense report number or PCard transaction number , dated was lost or not obtained, and (b) that these expenses have not yet nor will again be submitted to Harvard University or any other organization for reimbursement or tax purposes. Signature of Payee/Cardholder Date REQUIRED Authorized Signature Date REQUIRED DOCUMENTATION REQUIREMENTS The University requires individuals to submit the following documentation to substantiate all expenses in excess of $75. Air/Rail original ticket receipt Hotel hotel folio is required for all lodging expenses, regardless of cost. Car Rental car rental agreement receipt Personal Car Usage receipts for tolls and parking and daily mileage log listing date, itinerary, and number of
miles Meals/Entertainment credit card receipt or cash register receipt (no restaurant tear tabs) Receipts must include the name of the vendor, location, date, and dollar amount. Detailed cash or sales receipts Packing slips with a dollar amount Subscription or dues forms Please Note: Some schools require receipts for all expenses. Transactions under $75 do not need receipts unless otherwise required by the individual school or
because of conflict with funding agency requirements. Lodging transactions require hotel folio
regardless of amount. MISSING RECEIPTS General Individuals must attempt to obtain a copy of the original receipt from the vendor for all travel costs in excess of $75.
Missing receipt affidavits must be signed by both the individual and authorized signer with a complete explanation
of the expense if a copy of the receipt is unobtainable. PCard Receipts Cardholders are required to obtain original receipts for all transactions in excess of $75. If this is not possible, a
missing receipt affidavit must be completed and signed by the cardholder and the PCard administrator. Airline Ticket Receipt In the event of a missing airline receipt (last page of the ticket stub), the affidavit must be accompanied by some
form of documentation. The agency issuing the original ticket must be contacted and a copy of the receipt
requested. All agencies are required by the Airline Reporting Commission to keep copies of every ticket they issue. If the traveler is unable to obtain a copy of the airline receipt, acceptable alternatives are: A copy of the airline or agency
itinerary showing form of payment, the GE Corporate Mastercard statement or cancelled check. One must be included
with the missing receipt affidavit. Hotel Folio The IRS requires a hotel folio or itemized bill for all lodging reimbursements. The $75 limit does not apply to
lodging expenses. For complete information on expense reporting, please refer to the Harvard University Travel and Entertainment
Policy and Reference Manual.

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