Relocation Expense Certification Checklist
Please complete this checklist to certify and document your relocation expenses for review and approval.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Department or Position
*
Relocation Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Relocation End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Origin Location (City, State/Country)
*
Destination Location (City, State/Country)
*
Please indicate which of the following expenses you are certifying for reimbursement:
*
Transportation (airfare, train, etc.)
Temporary lodging
Meals during relocation
Moving company or shipping costs
Storage fees
Other (please specify)
Total Amount Claimed (USD)
*
Upload supporting receipts or documents for your claimed expenses
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Relocation Certification Checklist: Please confirm you have completed each step below.
*
Rows
Completed
Reviewed relocation policy
1
Obtained prior approval from supervisor
2
All receipts are attached
3
Expenses comply with policy requirements
4
Expense report is complete
5
Additional Comments or Notes (optional)
Signature (please sign to certify your claim)
*
Submit Certification
Submit Certification
Should be Empty: