---
title: Expense reimbursement form template, free
description: A free expense reimbursement form template. Claim back expenses: each item, date, amount and purpose, with receipts attached, approved by a manager. No bank details are collected. Publish it as one link; every response is its own signed copy.
---

# Expense reimbursement

Claim back expenses: each item, date, amount and purpose, with receipts attached, approved by a manager. No bank details are collected.

Receive complete claims with receipts, approved before payment.

## About you

- Full name (text)
- Email (email)
- Team or budget (text, optional)

## Items

- Item 1 (text)
- Item 1 date (text)
- Item 1 amount (text)
- Item 2 (text, optional)
- Item 2 date (text, optional)
- Item 2 amount (text, optional)
- Item 3 (text, optional)
- Item 3 date (text, optional)
- Item 3 amount (text, optional)
- Total (text)
- Receipts (file (PDF or picture))
- More receipts (file (PDF or picture), optional)
- These expenses were paid by me for the organisation's purposes, have not been claimed before and are not being paid back (tick box)

## Signature

- Claimant signature (signature)
- Claimant date signed (date signed)

## For approver use

- Decision (choice)
- Note (text, optional)
- Approver signature (signature)
- Approver date signed (date signed)