S Corporation Accountable Plan Agreement Form
Use this form to provide the employee or owner details, company information, reimbursement period, covered expenses, and agreement acknowledgment for an S corporation accountable plan.
Employee / Owner Information
Full Name
*
First Name
Last Name
Job Title / Officer Role
*
Email Address
*
example@example.com
Company and Position Details
S corporation legal name
*
Business address or primary office location
*
Department or team
Accountable Plan Agreement Details
Expense Reimbursement Period Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Expense Reimbursement Period End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Business Expenses Covered by This Plan
*
Agreement Confirmation
*
I confirm that expenses submitted under this accountable plan are business-related and properly documented, and that any excess reimbursements will be returned within the company policy timeframe.
Submit
Should be Empty: