UNDE Member Expense Claim

Address –
Claiming wages – YES provide your SIN number () NO

Direct Deposit – YES please include banking information / NO

Activity Information – Required

Expense	Amount

1. Travel
Total: $0.00

2. Accommodations

3. Meals
Left home Thursday, 01 January 1970	Arrived home Thursday, 01 January 1970
Total: $0.00

4. Wages (if claiming wages, attach approved leave document)
Classification and Level
Daily rate Days claimed	$0.00

5. Miscellaneous
Total $0.00

Total: $0.00 Less Advance: $0.00 Net Claim: $0.00

Official Use Only approved by: code: date paid: chq#

---

I certify that these expenses were incurred for Union business and that not part of said expenses were or will be reimbursed from any other source.