ClauseryFree expense reimbursement form template (Word)
An expense reimbursement form with a line for each expense (date, description, category and amount), an optional mileage claim, the total, any advance already received, receipts, payment details and an approval signature.
Does the maths for you: fill it in online and the expenses total, mileage, total to reimburse and balance due to you are calculated as you type.
No sign-up. Your answers stay in your browser. Who it is for: Employees and contractors claiming business expenses, and small businesses that want a consistent claim form without expense software.
Updated · Word (.docx) · Free to use and adapt
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What is in the expense reimbursement form
- Claimant, company, department and period
- Expense lines with date, description, category and amount
- Optional mileage claim
- Total and optional advance with balance due
- Receipts attached or missing receipt explanation
- Payment details
- Declaration and approval
Read the full template
This is the complete wording. [Labels] are filled in from your answers, and highlighted text only appears when it applies; hover over it to see when.
[Company] Claimant: [Your name] Department or project: [Department or project] | EXPENSE CLAIM Expense period: [Period start date] to [Period end date] |
Date | Description | Category | Amount |
|---|---|---|---|
| Repeated for each expense | |||
[Date] | [Description] | [Category] | [Amount] |
Expenses | [Expenses total] |
Mileage, [Miles driven] mi × [Rate per mile] | [Mileage] |
Total to reimburse | [Total to reimburse] |
Less advance received | −[Advance received] |
Balance due | [Balance due to you] |
Mileage was for: [What the trips were for].
Receipts for every expense are attached.Missing receipts and why: [Missing receipt reason]
Pay to: [Pay to]
I confirm that these expenses were incurred for business purposes, have not been claimed before and are not being claimed from anyone else.
Claimant: ____________________________ Date: ______________
Approved by: ____________________________ [Approver's name] Date: ______________
The questions you answer
Clausery turns the template into a short questionnaire. Optional parts only appear when they apply, and anything marked Calculated for you is worked out from your other answers.
| Question | Type | Asked when |
|---|---|---|
| Your name | Short text | Always |
| Company | Short text | Always |
| Department or project | Short text | Always |
| Period start date | Date | Always |
| Period end date | Date | Always |
| Expenses For each item: Date, Description, Category, Amount | Repeating group | Always |
| Expenses total | Calculated for you | Always |
| Claim mileage | Yes / no | Always |
| Miles driven | Number | If “Claim mileage” is yes |
| Rate per mile | Money | If “Claim mileage” is yes |
| Mileage | Calculated for you | If “Claim mileage” is yes |
| What the trips were for | Long text | If “Claim mileage” is yes |
| Total to reimburse | Calculated for you | Always |
| You received an advance | Yes / no | Always |
| Advance received | Money | If “You received an advance” is yes |
| Balance due to you | Calculated for you | If “You received an advance” is yes |
| Receipts are attached for every expense | Yes / no | Always |
| Missing receipt reason | Long text | If “Receipts are attached for every expense” is no |
| Pay to | Long text | Always |
| Approver's name | Short text | Always |
How to use it
Open it
Click Fill it in now. The template opens in Clausery with its questionnaire ready.
Answer the questions
Work through the sections. Drafts save as you type, on your device.
Download the document
Get a finished Word file with your formatting intact, or print it to PDF.
Prefer to start from your own wording? Download the Word file, edit it, keep the {tags}, and upload it to Clausery. See the template syntax.
Questions
What should an expense reimbursement form include?
Who is claiming, the period, each expense with its date, purpose, category and amount, the total, receipts, and a manager's approval.
What mileage rate should I use?
Many US businesses use the IRS standard mileage rate, which changes each year; other countries publish their own rates. Use your company's policy if it has one.
What if I lost a receipt?
Explain what the expense was and why the receipt is missing. Many policies accept a written explanation for small amounts.
Is it really free?
Yes. The download is free, and filling it in with the Clausery app is free too, with unlimited documents. Library templates never count towards a plan limit, and no account or card is needed.
Is my information uploaded anywhere?
No. Clausery runs entirely in your browser. Your answers and the finished document are created and stored on your own device.
Is this legal advice?
No. These are general samples. Laws differ between countries and states, so have the wording reviewed for your situation before you rely on it.
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This template is a general sample and not legal advice. Laws vary by jurisdiction; have it reviewed before use.