The Mileage Form Template – Canada is provided in multiple formats including PDF, Word, and Google Docs. Each version is both modifiable and ready for printing, making it easy to use according to your preferences.
Mileage Form Template – Canada Editable – PrintableSample
1. Employee Information 2. Trip Details 3. Date of Travel 4. Purpose of Trip 5. Mileage Information 6. Reimbursement Rate 7. Total Mileage Reimbursement 8. Additional Expenses 9. Total Amount Claimed 10. Employee Declaration
PDF
WORD
Examples
[Employee’s Name]
[Employee’s ID]
[Department Name]
[Start Date] to [End Date]
[Vehicle Make & Model]
[License Plate Number]
Date Destination Purpose of Trip Starting Mileage Ending Mileage Total Miles [Date] [Destination] [Purpose] [Starting Mileage] [Ending Mileage] [Total Miles]
[Total Miles Calculation]
The current reimbursement rate as per the Canada Revenue Agency (CRA) is [Rate] per kilometer driven for business purposes.
[Total Amount Calculation]
I hereby certify that the above information is accurate and that the mileage claimed was incurred for business purposes.
[Employee’s Signature]
[Date]
[Employee’s Name]
[Employee’s ID]
[Department Name]
[Start Date] to [End Date]
[Vehicle Make & Model]
[License Plate Number]
Date Destination Purpose of Trip Starting Mileage Ending Mileage Total Miles [Date] [Destination] [Purpose] [Starting Mileage] [Ending Mileage] [Total Miles]
[Total Miles Calculation]
The reimbursement rate in accordance with the CRA is [Rate] per kilometer driven for business purposes.
[Total Amount Calculation]
I affirm that the information provided above is true and that the mileage stated was incurred for business purposes.
[Employee’s Signature]
[Date]
Printable
