Expense Disclosure Reporting Form Page 1 of 1 Date of expense Destination Purpose Airfare Other Transportation Accommodation Meals (includes per diem allowances) Seminar / Conference / Registration fees Total 1 13-Jun-19 Yellowknife To attend AWCBC Governance Summit $60.36 $582.75 $96.00 $739.11 2 25-Jun-19 Edmonton To attend Board Committee and Board Meetings $105.00 $29.35 $11.00 $145.35 3 $0.00 4 $0.00 5 $0.00 6 $0.00 7 $0.00 8 $0.00 9 $0.00 10 $0.00 $884.46 Dates Total 1 $0.00 2 $0.00 3 $0.00 4 $0.00 5 $0.00 6 $0.00 7 $0.00 8 $0.00 9 $0.00 10 $0.00 $0.00 $884.46 Notes Travel, Seminars/Conference and Associated Expenditures Travel Related Name: For the Period: Jun-19 Ivana Niblett, Board Member Non-travel related Expenditures (Business meals, etc…) Purpose Notes Total claimed for reporting period: Non-Travel Related
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Expense Disclosure Reporting Form
Page 1 of 1
Date of expense Destination Purpose Airfare Other Transportation AccommodationMeals (includes per
diem allowances)Seminar / Conference /
Registration fees Total
1 13-Jun-19 YellowknifeTo attend AWCBC Governance Summit $60.36 $582.75 $96.00 $739.11
2 25-Jun-19 EdmontonTo attend Board Committee and Board Meetings $105.00 $29.35 $11.00 $145.35
3 $0.004 $0.005 $0.006 $0.007 $0.008 $0.009 $0.00
10 $0.00
$884.46
Dates Total1 $0.002 $0.003 $0.004 $0.005 $0.006 $0.007 $0.008 $0.009 $0.00
10 $0.00$0.00
$884.46
Notes
Travel, Seminars/Conference and Associated Expenditures
Travel Related
Name: For the Period: Jun-19Ivana Niblett, Board Member
Non-travel related Expenditures (Business meals, etc…)Purpose
Notes
Total claimed for reporting period:
Non-Travel Related
Expense Disclosure Reporting Form
Page 1 of 1
Mileage & Per Diem Allowances
Employee Name Expense TypeSubmitted
Date Trip InfoTrip Start
DateTrip End
DateExpense
Trans Date Detail DescriptionTotal Amount
(Includes GST/HST)Summary Item
Reference
Ivanna Niblett Travel Meal Allowance 6/28/2019
01. 06/10/2019 at 01:00 PM to 06/13/2019 at 11:15 PM - Yellownknife [OoP] Northwest Territories [C/S] ~ AWCBC Governance Summit June 10-13 2019 6/10/2019 6/13/2019 6/13/2019
3 day Per Diem allowance, Dinner on June 10, 11 & 13 $96.00 1
Ivanna Niblett Travel Meal Allowance 6/28/2019
02. 06/25/2019 at 05:00 AM to 06/25/2019 at 05:00 PM - Edmonton ~ June 25th WCB Board of Directors meeting 6/25/2019 6/25/2019 6/25/2019
1 breakfast meal allowance while enroute to Edmonton for Board meeting $11.00 2
GST 833 250210 RT0001
Park2Go Value Valet Calgary 2121 100 AVENUE NE Calgary, AB T3J 3N5 403-532-4844
Ticket # Park2Go Ticket Terminal DReservation # Rate 6 - Other Discount/Coupon ratOpen Date 06/10/19 14:09Close Date 06/13/19 22:17Timespan 3 dys, 8 hrs, 8 mins
Cashier ID 2204Date 06/13/19 22:17Customer 134107Name NIBLETT, IVANAVehicle License Lot Location
PARKING CHARGES Days 4 $ 59.81Discount - WESTJET CUSTOM 15.000% $ 8.97-Tip Valet 1 $ 5.00Subtotal $ 55.84Airport Access Fee $1.880 flat $ 1.88GST 5.000% $ 2.64 -------Parking Total $ 60.36
Grand Total $ 60.36
PAYMENTS 06/13/19 22:17 $ 60.36 TTID: Auth: Batch: 48
Tip Valet + ________________
Total = ________________
X_____________________________________________
Thank you for your business!
Electronic Miscellaneous Document (EMD) ReceiptPrepared ForNIBLETT/IVANA MS
RESERVATION CODE
ISSUE DATE 25Jun2019
DOCUMENT NUMBER
ISSUING AIRLINE WESTJET
ISSUING AGENT WestJet/MK7
Electronic Miscellaneous Document / Other Charges
Reaso n fo r Issuance Descript io n/Co de LAT E SHOW ECONO / D
Airline Designat o r WS
Co upo n Base Fare CAD 100.00
Payment Details
Tax/Fee/Charge CAD 5.00
To t al EMD Amo unt CAD 105.00
Fo rm o f Payment CREDIT CARD -
Important Legal Notices
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