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CAN^ADI^IN
PA,tr I Ft E R^ln-mv
EI{EMIN
tlse of hrsond Artomobile
OnCOmpany'SBuSineSs
Month/,vrdsd
E E FER
EANADIIN
F
Utilisationd'une roiturc particulide
pendantun Wge dhffaircs
Occupation
function
Detailscoveringcar usage(for additionalspace,see back)
Debk,ibrelatifse l'utilisationde la voiture(6crireau versosi ndcessarre.)
Sub-Total
Km/Miles
Totalkm/milles
I herebycertifythattheaboveis a correctstatement
of cartravelexpenses
incurred
by meon Company
Service.
Je certifiequece quiprAcbdereprdsente
mesfraisd'utilisation
d'unevoiturc
pdtticulibrependantun voyaged'affairespourle comptede la Societe.
In accordancewith policyno. 6302,
I hereby certify that this employee
shouldbe classifiedunder:
conformilment a h potitiqueno 6302,
je certifie que l'employd
' doit 6tre
c/assdcomme suit:
Total
Totalglobal
Basisof Reimbursement
lndemnit6de parcours
Amount
Montant
$
Examinedand certifiedcorrect
V6rifi6et approuvd
_ CategoryI
L-) CatdgorieI
_ category rl
L) catdgorie ll
_
f]
U.S.
Etats-Unis
CIFIEI|E
Totalcash advancesoutstanding
Totaldes avancesde fonds
Amountof this expenseaccounl
Montantdu presentcompte de frcis
Balanceof advancereturnedto Company
Reliquat d restituer A la SocldtC
Amountdue to employee
Montail d0 a lemploy€
_:!
C^A,NAI'I^A,N
PAGI FIc
]IAI LWAY
Artomobile
Useof Ferconal
on Company'sBuSineSs
Month/Moisd
GHEMTN
E E FER,
EAN^AE TEN
FAGIFIEUE
irc
Utilisationd'unevoiturcpartidufi
pendantun royaged'affaircs
Detailscoveringcar usage
D6tails relatifsd l'utilisation de la voiture
Basisof reimbursement
lndemnitfde parcours
In accordancewith policyno. 6302,
I herebycertitythat this employee
should be classifiedunder:
Amount
Montant$
Conform6mentd la politique no 6302,
ie certifie que l'employ6 doit 6tre
classecomme suit:
Signature
Approved
Approbation
_ Category|
L-J CatdgorieI
ll
Cateoorv
l) Catdgoriell
u.s.
n Etats-unrs
Head of DeoartmsntlChel& sevice
Formllmqimd 513t514
Rq.lR6v. OAl92CRg