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 the following:
? A copy of the itinerary invoice and form of payment (i.e., credit card statement, cancelled check)
? 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 (attach payment verification):
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 (attach payment verification):
Dates Rental Company Car Class* # of Days Total
__________ ____________________________ _________ __________ ___________ *C=Compact, M=Mid-size, F=Full-size
? Attached is a copy of the credit card statement, cancelled check, or other documentary evidence. Date Description (in detail) Total __________ ________________________________________________________ ___________ __________ ________________________________________________________ ___________
I, the undersigned, certify
(a) that each expense described above, reported on attached reimbursement request dated
_____________ was lost or not obtained, and
(b) that these expenses have not yet nor will again be submitted to this or any other organization
for reimbursement or tax purposes.
Employees will be responsible for payment of all tax penalties and organization expenses related to their
lack of original receipts.
Signature of Payee ______________________________________________ Date ________
Supervisor’s Signature ____________________________________________ Date ________
UNC Charlotte requires individuals to submit the following documentation to substantiate all expenses
other than subsistence.
? Air/Rail – original ticket receipt ? Hotel – hotel folio is required for all lodging expenses, regardless of cost. ? Car Rental – original 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 – cash register receipt and proof of payment (does not apply to travel
? 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
Individuals must attempt to obtain a copy of the original receipt from the vendor for all travel costs.
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.
In the event of a missing airline receipt (last page of the ticket stub), boarding passes or other original
document, the affidavit must be accompanied by some form of documentation that substantiates the
payment. The travel agency issuing the original ticket must be contacted and a copy of the receipt
requested. All travel 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, a credit card statement, or a cancelled check. One
of these must be included with the missing receipt affidavit.
The IRS Accountable Plan requires a hotel folio or itemized bill for all lodging reimbursements. In the
event of a missing original paid receipt, a copy of the online booking or other documentation with proof
of payment is required with the missing receipt affidavit.
For complete information on expense reporting, please refer to the UNC Charlotte Travel Procedure