Expense Disclosure Reporting Form

Transcription

1 Expense Disclosure Reporting Form Name: Dieter Brunsch, VP Customer Service & Risk Management For the Period: March 2013 Travel, Seminars/Conference and Associated Expenditures Date of expense Destination Purpose Airfare Other Transportation Accomodation Meals (includes per diem allowances) Seminar / Conference / Registration fees Total 1 11 Mar 13 Calgary JSSS Annual General Meeting & Board Meeting (includes changes to flight made on March 18, 2013) $ $ $ Mar 13 Calgary/Balzac ITF meeting in Balzac (March 13); CAPP meeting in Calgary $ $ $45.95 $ (March 14) 3 $ $ $ $ $ $ $ $0.00 Notes Travel Related $1, Non travel related Expenditures (Business meals, etc ) Dates Purpose Expense Category Total 1 18 Jan 13 Business Lunch with external represenative $ Non Travel Related $66.78 Notes Total claimed for reporting period: $1, Page 1 of 1

2 .\ _.,.._.,.._...,...,..,..&..o..t.~ JLto.U.A..o~'I..J V.J'\.l''f::, '-" V.l..l.I.!..A. J...lJ.ULlVIl Itinerary /Receipt ri1g~ 1 Ul L. Your booking Is confirmed. Please print/retain this page for your financial records (e.g. fo r taxation, expense claim or payment card recondllation purposes). We thank you for choosing Air Canada and look forward to welcoming you on board. Booking Information AIR CANADA@ Booking Reference: 1 Electronic Ticketing confirmed. This Is your official itlne.rary /receipt. Main Cont act: Flight Itinerary Customer Care Air Canada Flight Arr ivals and Departures ~v~l j). \:J ( Lt (\~c.) JSSS -.A--f;M cl) 3o~\) '{VI:_~. Flight From To AC Edmonton, calgar y ( YYC) Edmonton Int'l l~on 18-Mar 2013 ( YEG ) 08:23 M"n 18-MM :30 1 AC8152 Calgary (YYC) Edmonton, Mon 18-Mar 2013 Edmonton I nt'l 16:30 (YEG) Mon 16 Mar :24 Stops DuratiOn 0 OhrS3 0 Oh r54 Aircraft Ct<l DH3 Fare Type Tan.jO, G Tango. G Meal Operated by: 1 A1r Canada ElCpress Jazz Passenger Infor mation 1: Mr Dieter Brunsch : Adult (16+ ), Ticket Number: Air Canada Aeroplan : Payment card: Seat Selection: None "'fane Paid CongratulatiOns on your selection of a Preferred seat. Pleas~ read the Tenns and conditions. Purchase Summary Far e Summary Passenger Type Departing Flight - TanQo Return Flight - ::t:jrc"ler,..e '"~" Adult T axes, Fees and Charges Canada Goods and Serv1ces Tax (GST/HST RTOOO!) A~r Travellers Secur~ty harge (ATSC) Total airfare and taxes before options (per passe11ger) Options Departing Flight - ango Advance Seat Selection (Pre'erre J) Return Flight - a ss.oo u.oo Advance seat Selection ("ree e J) Canada Goods and Services Tax (GST/HST RTOOOI) _ 2:.;-~7.:.0_ Total airfare, taxes and options (per passenger) Number of passengers 1 Travel i nsura nce (declined) 0.00 Grand Tot al Canadian dollars Payment Information $425.S1 AConline/en/BookTripPlanServlet;jsessionid=vcXIR91 CSB... 3/11/2013

3 AIR CANADA {i) Electronic Refund Receipt I Re<;u de remboursement electronique We are pleased to confirm a refund has been processed to your payment card. Nous sommes heureux de confirmer qu'un remboursement a ete porte a votre carte de paiement. Please print this refund receipt for your reference. Veuillez imprimer ce re~u pour vos dossiers. Refund Information 1 Details du remboursement Passenger Name: Nom du passager: Ticket(s) Refunded: Billet(s) rembourse(s): Payment card refunded: Carte de paiement remboursee: Date of refund: Date du remboursement: Dieter Brunsch March Mars 2013 Customer Care Service au client On the web/site Web nada.com Air Canada Reservations Reservations d 'Air Canada Aeroplan Centre Centre Aeroplan Amount refunded I Montant du remboursement Amount eligible for refund: Montant a rembourser : Taxes and Airport Fees eligible for refund : Taxes et frais aeroportuaires a rembourser: Canada Goods and Services Tax (GST/ HST # ) I Canada - Taxe sur les produits et services (TPS/TVH # ) (XG) Total Amo unt Refunded to your p ayment c ard in Canadian dollars: Monta nt total r embourse sur Ia cart e d e p aiem ent en Dollars canadiens: ~ s:\a.~ i:"~ IJ {\ i c)~~ tj-~~-f- 1 (A~l( "b -~(LU\.~~

4 AIR CANADA (j) Fare Summary Passenger: 1 Ticket number Date of i&&ue Fare Amount in Canadian dollars: (including navigational & othet t.hdt ues ) Taxes, Fees & Charges Canada Goods and Services Tax (GST/HST # ) (XG) Combined Taxes *see fare calculation below (XT) Total Fare in Canadian dollars: Options Seat selection fee in Canadian dollars Canada Goods and Services Tax (GST/HST # ) (XG) Seat selection fee in Canadian dollars Canada Goods and Services Tax (GST/HST # ) (XG) Change fee in Canadian dollars Canada Goods and Services Tax (GST/HST # ) (XG) Ticket pa rticu Ia rities: AC ONLY/NON-RFF/CHGE FEE 10- l\1er 201J PO 39.90A / *Fare calculation: 18MAR13YEA AC YYC Q12.00R129.00AC YEA Q12.00R167.00CAD END ROEl.OO PD14.25CA17.56XG55.00SQ Canadian tax registration numbers: XG Cana da Goods and Service Tax (GST) # RC Canada Harmonized Sales Tax (HST) # XQ Quebec Sales Tax (QST) # Fare Rules Voluntary changes to your itinerary may require the payment of additional fees and fare upgrades. If you are travelling on a non-refundable ticket, Air Canada will be unable to make exceptions in the event of an unexpected trip cancellation or medical emergency. We recommend the purchase of travel insura nce. Tickets are non transferable and name changes are not permitted. Advance seat assignments are not guaranteed and may be changed without notice. If your pre-assigned seat is unavailable, we will try to accomodate you in a comparable seat in the sa me class of service and will refund any applicable refundable fees. Important Information This is your E-ticket itinerary/receipt. Keep this document for your travel. Your flight coupons are stor ed in our reservation system. The Conditions of Contract and other legal notices are provided with this itinerary/receipt. Please review this itinerary/ receipt and should you have any questions, please call within 24 hours of receipt. Travel Documents Air Canada is required by federal government regulations to check identification at the departure gate for all passengers who appear to be 18 years of age or older. The name on the identification must match the name used on the reservation or ticket. The passenger must present: one (1) piece of government-issued ID with photo or two (2) pieces of government-issued ID without photo. For air travel between Canada and the United States, all passengers incl uding Canadian and U.S. citizens, are required to present a valid passport or other valid travel document such as a Nexus card. Nexus members are required to carry appropriate immigration and identity documents in addition to their Nexus card. In addition, passengers must present this Itinerar y/receipt to immigration authorities upon request. For air travel to a foreign country, passengers must ensure that they have all necessary travel

5 GST# R Edmonton Airports '. Can- TS ) ' 2T2 Edmonton ' Tax CodeCAS% POF 2nd Fl 18/03/13 17:02 Re ceipt Short- term parking tkt HL _ No /03/13 06: /03/13 06 : 09 Period 1d0h0 ' $23.00 (Tax) $23.00 Total Merch: Auth: Type: Swiped S Sub Total ' Tax 5% g p ~ $ $ DISP~AY '. TICKET ON DASH Expiration Date!Tirre EXP 06:00PM MAR 18, 2013 Purchase Date/Time: 08:55am Mar 18, 2013 Total Parking: $38.00 Total Federal: $1.90 Total Due: $39.90 Rate: Early Bird Rate Total Paid: $39.90 Payrrent Type: Card SiN#: Setting: lot 31 Mach Nacre: lot 31-2 GST REG #XI RECEIPT Auth #: Expiration Date/Time: 06:00pm Mar 18, 2013 Purchase Date/Time: 08:55am Mar 18, 2013 Total Parking: $38.00 Total Federal: $1.90 Total Due: $39.90 Total Paid: $39.90 MasterCard I Ticket #: Setti : lot 31 Mach '\me: lot 31-2 Rate: Early Bird Rate Payment Type: Card Auth #: 1XJ03B GST NO R BRUNSCH,DIETER WIZ = cv - FTN CA/ JG OUT YYC 18MAR13/0915 KM = 5379 IN YYC 18MAR13/1433 KM = KM@. 00 = 5 HR@ = DY@ = MINIMUM CHARGE = GST TAX = *$6/DY FEE = ** % FEE = FTP SR$ 0. 75DY* = ENE RGY RECOVERY = TAXABLE SUBTOT = PST.000% = FUEL SERVICE = TOTAL CHARGES = **CONCESSION RECOVERY FEE *CUSTOMER FACILITY CHARGE *CUSTOMER FACILITY CHARGE *FTP SUR $ 5.25 MAX FF MLS/PNTS EARNED 'Suvv\JV\~ ~ ~t;ij. j).~"-'s&- ~ '. J{)b s-~~q_~ ~~\\S ~U--~ ~~

6 Sheraton Cavalier Hotel Calgary Avenue N. E. Calgary; AB T1Y 6B8 Canada Tel : Fax : Dieter Brunsch Po Box 2415 Stn Main Edmonton, AB T5J 2S5 Canada Page Number : 1 Guest Number: Folio ID EX-A No. Of Guest: 1 Room Number : 742 Room Rate Club Account : Arrive Date: 13-MAR : 45 Depart Date: 14 - MAR-13 Information Invoi ce Tax ID: GST- r Sheraton Cavalier 14-MAR : 51 ROMANO Date Reference Description Charges Credits 13-MAR-13 RT742 Room Charge (CT) MAR-13 RT742 Alberta TL Tax ~-13 RT742 DMF '-MAR.-13 RT742 GST t.mfill :- 1:3 ' MC Mastercard ** *** Total Balance 0.00 For your convenience, we have prepared this zero-balance folio indicating a $0 balance on your account. Please be advised that any charges not reflected on this folio wi ll be charged to the credit card on file with the hotel. While this folio reflects a $0 balance, your credit card may not be charged until after your departure. You are ultimately responsibl e for paying all of your folio charges i n full. Suvn_~{loJ Continued on the next page ~N'-- {_~ ~f ")).~faf uj-e-ty-.16"bt -\ t M-A:e.Lk\ I~ M-~ - t'tf' ~ f\. ~ zac.. ~~t'l..~l)~ t vv...t\i..t...8- \ '1- rv..-+j.- CA\'P \~La.~~~

7 Sheraton Cavalier Calgary Colors Cafe nd Ave. N.E. Calgary, AB T1Y 6B8 GST if R Sandy C ~ Tb 1 24/1 Chk Mar'13 07:58 Gst ~ Toast 1 Coffee Subtotal 5.75 GST 07:58 Total. I u--v Gratu1 ty..:.. 1 _ Total 7, Room Number _ 0~ Print Nalile Signatut~ Thank You _ Please Pay Your Cashier!!! EARLS RESTAURANTS. earls GRE:AT FOOD GHEAT PEOPLE,, 104 Susan E '-...: Tbl 144/ 1 Chk 6640 Gst 1 13Mar'13 06 :04PM POP 1 POP REFILL 1 CAjUN CHICKEN Subtotal GST Tax 06:39PM Total earls Please PaY your server Thank you fo r coming! We hope to see you soon! GST# HNSHOST HARVEY S t~ AlN CALGARY INTERNATIONAL AI RPORT 5354 Gur vinde 1916 HAR14'13 1:13PN CMB VEG BURG FRIE S SODA FTN 32 ADD CHEESE SUBTOTAL TAX At 10UtH DEBIT CARD THANK YOU FOR VIS ITING HARV EY' S GST if s(a_r\\~ *L ~1\.-T'J. b ~ (LU\Sc.-k

8 Mileage & Per Diem Allowances Employee Name Expense Type Submitted Date Dieter Brunsch Per Diem 3/19/2013 Trip Info Trip Start Date Trip End Date Expense Trans Date Detail Description Total Amount (Includes GST/HST) Summary Item Reference Association Meetings: ITF and Per Diem Allowance for CAPP 3/13/2013 3/14/2013 3/14/2013 Incidental Costs $6.00 2

9 tprp~~ RECEIPT PLACE RECEIPT ON DASH VINCI Park Petroleum Club Lot # 045 License Plate Nurrber J24341 Expiration Oate/Tin:e 07:00 PM MAR 14, 2013 Purchase Date/Time: 08:49am Mar 14, 2013 Total Due: $37.00 Rate: Day Max 7 PM $37 Total Paid: $37.00 Payment Type: Card Ticket #: SIN #: Setting: Petroleum Luke II Mach Name: Petroleum 12 Card #' GST # r Thank You VINCI Park GST# RJ.<:8 5 ~9776 Edm on t ~n Ai rports Can-TSJ 2T2 Edmonton Tm. : o.dect1!i% Exi t Lane 14/03/13 15:42 Receip1: 0'12601 Short-term parking t kt HL - No /03/ : /03/ :34 - Period <:cioho' (Tax) $46.00 Total $46.00.~ Sub i~ Tax ~ '" '" Tol:<tl C'Q,'. I..Iii $46.00 :~ Calgary Airport Husk 9100 Barlow Trai I NE Calgary AB (403) GST# Retailer ID Rct : Batch: Item Arnoun t Eth Regular xS1.119L AMOUNT S8.85 An (:.;:, 1 \.1fl(; ruiup' 2013/03/14 13:06 : 01 Approved - Thank you Earn FREE fuel fast! Register today at myhuskyrewards.ca

10 Your Information Your Vehicle Information Customer Name: Wizard Number. Avis Worldwide Discount: Customer Sta tus: Method of Payment: FrP.rpiPnf TrAveler Number DIETER BRUNSCH Vehicle Number. Vehicle Group Rented: Vehicle Group Charged: Vehicle Description: License Plate Number: Odomotor Out: Odometer In: Total Driven: Fuel Gauge Reading: Compact Compact BLK KIA RJ05 ABJ Full Your Rental Pickup Date/Time: Pickup Location: MAR 2000 AIRPORT ROAD CALGARY INTERNATIONAL AIRPORT CALGARY,AB,T2E 6W5,CA Return Datenime: Return Location: MAR 2000 AIRPORT ROAD CALGARY INTERNATIONAL AIRPORT CALGARY,AB,T2E 6W5,CA Additional fees may apply if changes are made to your return date. time and/or location. Your Vehicle Charges (MIN 1 DAY) our Optional Products/Services Rate Chart: Free Kilometres: Time and Kilometres: Kilometres:UNLIMITED Hourly: Daily: Ad'l day: 0.00 Weekly: Monthly: Your Discount: 2 DY@ = Time and Kilometres: Optional Services Total: 0.00 Your Taxable Fees 'S61DY FEE 15.61% Concession Recovery Fee ENERGY RECOVERY FEE 0.98/DY Sub-total-Charges: Your Non-Taxable Products/Services GST TAX 5.00 % 5.35 Your Total Charges paid: Prepayment Travel Partner Points Earned: 500 Charges: Total Due: Thank you for renting with Avis. For all other inquiries, please contact us at 1 800~ or WW\v.Avis.com. At Avis, we are committed to providing you with the best rental experience in the industry. We are in the business of treating people like people. Your vehicle was rented to you by ARSALAN. Your vehicle was checked in by RAJINDER.

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