Appendix F - Sample declaration

Note: This document is intended only as a sample to illustrate the information that should be contained in a declaration when original receipts or copies are lost, accidentally destroyed or unobtainable.

SAMPLE LOST OR DESTROYED RECEIPT DECLARATION

Declaration by Claimant - To be used in lieu of unavailable receipt
 

I, 

  

hereby

  
 

declare that I have paid for the following goods or services incurred by me on travel for government business and that the invoice was: 

  
   

Lost

  
   

Destroyed

  
   

Inadvertently not obtained

  
   

Other (specify):

  


Invoice detail:

Date

Person / Business

Amount
   

$      

GST/HST

$

TOTAL

$

Description of Goods or Services provided:
  

  

  

  

 

Signature of Claimant
Index