Missing Receipt Affidavit

Missing Receipt Affidavit

When a receipt is lost or otherwise unavailable, and all measures to obtain a copy have been exhausted, a Missing Receipt Affidavit should be completed. Please note this form will only be accepted in lieu of a receipt in rare and exceptional circumstances. Excessive use of this form is not permitted and routine lost receipts may result in deductions from your salary.
Name*

First NameLast Name
I am missing a receipt for: *
(List items in transaction, this must be a detailed explanation, "Tesco" or "Amazon" is not permitted)
I incurred this expense at: *
(Business Name)
Date*

DayMonthYear
Date
Transaction Amount *
The Receipt was:*

LostNever ReceivedOther
Payment Form*

Corporate Credit CardPersonal Card / Cash
Please enter your Barclaycard PO number for this transaction*
Business purpose for transaction*
Person(s) involved
(If expense is related to travel or entertainment)
I understand that a Missing Receipt Affidavit should only be used on rare occasions and may not be used on a routine basis. I understand that excessive use of a Missing Receipt Affadavit may revoke the priviledge of providing a declaration of receipt and expenses may be deducted from my salary.

By submitting this form, I am certifying that the amount shown is the amount I paid; that I have not and will not submit a duplicate claim and that I have not and will not seek a claim for these expenses from any other source.
Signature*

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