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Missing Receipt Affidavit

This form is for when a receipt is missing from a card transaction that was paid via virtual card (any amount), or from a standard reimbursement expense (of $75 or less).
Repeated missing receipts will result in the loss of virtual card privileges for the individual, or if project-wide, for the sponsored project, at the discretion of the Raft Foundation administrative team.

Your name

Your email address

Raft project

The name of the Raft project you are associated with.

What form of expense is this?

What form of expense is this?
A
B

Are you the one who paid this expense?

Are you the one who paid this expense?
A
B

What is the exact amount of the expense?

In USD. If you must enter a number that is not in USD, explain at the bottom of this form.

On what day did the payment take place?

What is the name of the vendor/payee?

What was purchased? What was the purpose of the payment?

Please explain why the receipt is missing.

What else do we need to know?

I attest that all information included here is true and accurate to the best of my knowledge. I understand that a Missing Receipt Affidavit should be used on rare occasions and may not be used on a routine basis. I further understand that excessive use of the Missing Receipt Affidavit may revoke the privilege of providing a declaration in lieu of a receipt. I certify that the amount shown is the amount I actually paid; that I have not and will not submit a duplicate claim; and that I have not and will not seek a claim for this expense from any other source.

Signature
Once you have submitted this form, we will follow up via email with a document that can be uploaded to in lieu of a receipt.