Travel Claim/Salary Repayment

Complete below to make a travel claim or salary repayment.

PEI UPSE Travel Claim Form

Mileage Rates: Single $0.60/km 1 addt’l Member $0.62/km 2 addt’l Members $0.64/km. 3 or more addt’l Members $0.66/km Short trip (20 kms or less) $12.00

MM slash DD slash YYYY
Home Mailing Address(Required)
Travel Claim Details
Date of meeting/event
What did you attend? (Meeting, conference, education)
# of Kms
Km. rate (.60 cents)
Meals/Misc
All other
$ Total
 
Short Trip – claim $12 (20 kms and under)
If members carpooled with you, please list names below
Please provide your Workplace/Employer and Department/Division if applicable
Salary Repayment Claim Details
Date you are claiming for Salary Repayment
Shift (ie. Day/Eve/Night)
# of hours paid (ie. 8 hour day = 7.5 paid hours)
Hourly wage
 
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