Brigham Young University-Hawaii

Purchasing and Travel Services

Lost or Missing Receipt Affidavit

Travel Application Number__________________________________

I, _________________________________________ certify that receipts and documentation required for travel expenses totaling $__________have been lost or are otherwise unobtainable. I have made attempts to obtain duplicate receipts and have been unsuccessful. The following receipts are missing in my Travel Expense reconciliation:

Date	Company	Amount
	Total

I verify that the undocumented expenses are approved, legitimate business expenses, and were incurred while in the active conduct of official University affairs.

Applicant Signature: _________________________________________ Date: _____________

Department Chairperson Approval: ____________________________ Date: _____________