Grants Reimbursement Form Step 1 of 2 50% This form is to be used to request reimbursement when purchasing expenditures such as books, software, equipment, materials, travel and conference expenses, and supplies with grant funds. Please submit this form within two months of incurring the expense. Please attach all expense receipts / documents below. If you are hiring a professional consultant or research associate to do editing, indexing or research with your grant funds, do not use this form. Instead, you need to submit Redeemer’s “Request for Payment of Services” form, and request that Redeemer pay the consultant directly. If your request for reimbursement is for more than your grant is worth, Redeemer is under no obligation to pay the excess amount. To find your funding account number, see your original award letter or Self Service. Upon completion, this form will be emailed to you and the Research Office (research@redeemer.ca) for approval. Please retain a copy for your records.Entry Date(Required) YYYY dash MM dash DD Email(Required) Name of grant holder(Required) First Last Is someone other than the grant holder being reimbursed?(Required) Yes No Information about the person being reimbursedName of person being reimbursed(Required) First Last Permanent address of person being reimbursed(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Description of Event / Item(Required) Start Date of Event / Item(Required) YYYY dash MM dash DD End Date of Event / Item(Required) YYYY dash MM dash DD Type of Grant(Required)IRGIDGITFGAPSSHRC SEGVandezandeNSERC DiscoverySSHRC InsightSSHRC ConnectionOtherExpensesAccount expense code(Required)e.g. 31-00-260400. Internal Funding accounts begin with 16, 31-34. External Funding accounts begin with 40-45, 47, 51, 52, or 56-58. Automobile (66000) – Expense Amount$0.52/km for first 250 km per round trip; $0.15/km for over 400 km per round tripAutomobile Description Automobile (66000) – Expense Amount #2$0.52/km for first 250 km per round trip; $0.15/km for over 400 km per round tripAutomobile Description #2 Airfare/Travel/Parking (66000) – Expense AmountAirfare/Travel/Parking Description Airfare/Travel/Parking (66000) – Expense Amount #2Airfare/Travel/Parking Description #2 Meals (66010)For meals in Canada. For international travel, see Travel Reimbursement Rates. Provide total and description in the box below. $60 per diem in Canada (Number of days x $60) Individual meals in Canada (breakfast $12; lunch $18; dinner $30). Submit itemized receipts for actual amount. Other (e.g. $50 USD per diem) Meals (66010) – Expense AmountMeals Description Accommodation (66010) – Expense AmountAccomodation Description Accommodation (66010) – Expense Amonut #2Accomodation Description #2 Conference Fees (66020) – Expense AmountConference Fees Description Conference Fees (66020) – Expense Amount #2Conference Fees Description #2 Honoraria/Stipends (61600) – Expense AmountHonoraria/Stipends Description Honoraria/Stipend (61600) – Expense Amount #2Honoraria/Stipend Description #2 Books (66440) – Expense AmountBooks Description Books (66440) – Expense Amount #2Books Description #2 Misc. Object Code Misc. Expense AmountMisc. Description Misc. Object Code Misc. Expense Amount # 2Misc. Description # 2 NotesIf any expenses require a supporting note, please provide here.Expense receipts/documents Drop files here or Select files Max. file size: 10 MB, Max. files: 10. Total expenses(Required)Less funds from other sourcesDescription Reimbursement Request(Required)USD payment Indicate if you require payment in US funds. Attestation(Required) By submitting this form, I am attesting that the above numbers are accurate and understand that the form will be sent to the Research Office for approval. {all_fields}