SURNAME*FIRST NAME*ADDRESS - Mailing (City / Town and Postal Code*LocalPhone*EMAIL* CLAIMING WAGES? Yes NoDIRECT DEPOSIT? Yes NoIF 'Yes' BANKING INFO MUST BE SUBMITTEDACTIVITY INFORMATION- REQUIREDACTIVITY ASSOCIATED WITH CLAIM*SelectMeetingConferenceTrainingNAME OF ACTIVITY*EXPENSETRAVEL Check all that apply.Mileage MILAGEMilage Input*KM @ $0.59Travel - Milage ResultParking PARKINGParking Input*Travel- Parking ResultTAXI TAXITaxi Input*Travel - Taxi - ResultOtherr OTHEROther Input*Travel - Other - ResultTravel TotalTravel TotalPlease specify nature of other expenses*ACCOMMODATION Check all that apply.Hotel HOTELhotel Input*Accommodation - Hotel - ResultPRIVATE ACCOMMODATION/LODGING PRIVATE ACCOMMODATION/LODGINGHow Many Days?*DAYS @ $50.00Private accomodation resultMEALSLEFT HOME DATE* MM slash DD slash YYYY TIME* : Hours Minutes AMPM AM/PMARRIVED HOME DATE* MM slash DD slash YYYY TIME* : Hours Minutes AMPM AM/PMCheck all that apply (Effective Date: October 1, 2021))BREAKFAST BREAKFASTBreakfast Input*@ $24.90Meals - Breakfast resultLUNCH LUNCHLUNCH Input*@ $25.20Meals -Lunch resultDINNER DINNERDinner Input*@ $61.85Meals - Dinner resultINCIDENTALS INCIDENTALSINCIDENTALS Input*@ $17.30Meals - Incidentals resultTravel TotalMeals TotalWAGES (includes top-up)For Treasury Board and CSE members claiming wages – please attach your approved leave document before submitting this form.CLASSIFICATION & LEVELDAILY RATE $DAYS CLAIMEDDAILY RATE TOTALAdd field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 2Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 3Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 4Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 5Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 6Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 7Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 8Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 9Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 10Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 11Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 12Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 13Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 14Add field +DAILY RATE $DAYS CLAIMEDDAILY RATE TOTAL 15MISCELLANEOUS Check all that apply.FAMILY CARE CLAIM FAMILY CARE CLAIM$*Misc - Family Care resultOTHER OTHERDescription*Amount*Other Bottom ResultDescriptionAmountOther Bottom Result TwoAdd field +HiddenDescriptionHiddenAmountHiddenAdd Result 1Add field +HiddenDescriptionHiddenAmountHiddenAdd Result 2Add field +HiddenDescriptionHiddenAmountHiddenAdd Result 3Add field +HiddenDescriptionHiddenAmountHiddenAdd Result 4Add field +HiddenDescriptionHiddenAmountHiddenAdd Result 5Add field +HiddenDescriptionHiddenAmountHiddenAdd Result 6Add field +HiddenDescriptionHiddenAmountHiddenAdd Result 7Add field +HiddenDescriptionHiddenAmountHiddenAdd Result 8Add field +HiddenDescriptionHiddenAmountHiddenAdd Result 9Add field +HiddenDescriptionHiddenAmountHiddenAdd Result 10Miscellaneous TotalMiscellaneous TotalDID YOU RECEIVE AN ADVANCE? Yes NoIF 'Yes' INDICATE THE AMOUNT*Advance TotalCommentsPlease provide any additional information or requests that are relevant to your claimComment BoxNET CLAIM (before statutory deductions)TOTAL ALL EXPENSESTo help faster processing: Include all receipts For Treasury Board and CSE members claiming wages – please attach your approved leave document before submitting this form. Include FAMILY EXPENSE FORM (if applicable) If DIRECT DEPOSIT was requested, please include a copy of a void chequePDF, .jpg, .png, .docx files accepted max 10MB file size.ATTACH FILES Drop files here or Select filesMax. file size: 2 GB. * By checking this box, I certify that these expenses indicated were incurred for Union Business and that not part of said expenses were or will be reimbursed from any other sourcePhoneThis field is for validation purposes and should be left unchanged.