RELOCATION REIMBURSEMENT CLAIM FORM:
(Policy #82: Relocation of Faculty Members and Senior Management Staff)
Name:
Employee ID:
Faculty or Department:
Start Date:
Job Title:
Duration of Employment:
Date of Relocation:
Pick-Up/Load Date:
_________________________________________
Previous residence (City, Country):
Accompanying family: ☐ Spouse/Common-law Spouse
☐ Dependants
# of Dependants:
Previous Relocation Claim Reimbursement from Policy #82:
☐ Yes
Journal Voucher Number(s):
Total amount reimbursed2: $
☐ No, this is a new request for reimbursement.
Salary Source: ☐ General Purpose Operating Funds (GPOF)
☐ Grant or Other1
Central Relocation Fund allowance2: $
Central Relocation Fund allowance for travel (exclude Pre-Move Visit or Post-Move Lodging)2:$
Central Relocation Fund allowance for tax and financial advising2: $
Total relocation cost2: $
Amount of relocation cost, if any, reimbursed by non-GPOF sources2: $
Total cost of Pre-Move House-Hunting Visit or Post-Move Temporary Lodging2: $
Total cost of Shuttles3: $
Date of Origin Shuttle4:
_
4
Date of Destination Shuttle :
_
Taxable Benefits (T4A required) : ☐ Immigration Fee: $
2
☐ Other Fees: $
Please submit this form with proper supporting documentation to:


UBC Vancouver – Financial Operations (5th Floor, 6190 Agronomy Road, Vancouver, BC V6T 1Z3)
UBC Okanagan – Finance Operations (ADM006 – 1138 Alumni Avenue, Kelowna, BC V1V 1V7)
Revised Aug. 10, 2016
Page 1 of 2
Authorization and Signatures:
I hereby certify that the following Relocation claim is in accordance with UBC Policy #82
(http://www.universitycounsel.ubc.ca/policies/policy82.pdf):
Administrative Head of Unit’s Printed Name:
Administrative Head of Unit’s Signature:
Date:
Direct inquiries to:
Notes:
1
If source of funding is not paid by GPOF, then the source of funding is expected to be the “first payer” of eligible
relocation expenses up to the amount permitted by the non-GPOF source. Non-GPOF sources may request
reimbursement from Central Relocation Fund for up to the shortfall amount or the eligible Central Relocation Fund
allowance.
2
Currency is in Canadian dollars. If expense is in US dollars or another foreign currency, please calculate in
Canadian dollars.
For period from April 1, 2015 to June 30, 2016 only, any shuttle expenses incurred during this time will be
reimbursed outside of the Central Relocation Fund allowance. After this period, any shuttle expenses
incurred on or after July 1, 2016 will be reimbursed within the Central Relocation Fund allowance.
3
Origin is the city or town from where the relocating faculty member or senior management staff is
relocating. Destination is the city or town (Vancouver or Kelowna) to where the relocating faculty member
or senior management staff is relocating.
4
Questions:

Reimbursement from Central Relocation Fund, please direct to:
UBC Vancouver : Jennifer Brunt at [email protected] in Financial Operations
UBC Okanagan: Ray Fahrun at [email protected] in Finance Operations

Relocation Policy #82, please direct to UBC Human Resources:
Relocation Administrator: Joyce Wei at [email protected]
Senior Manager, Health, Wellbeing, and Benefits: Natasha Malloff at [email protected]

Purchase Requisitions or Purchase Orders, please direct to Financial Operations:
[email protected]
Please submit this form with proper supporting documentation to:


UBC Vancouver – Financial Operations (5th Floor, 6190 Agronomy Road, Vancouver, BC V6T 1Z3)
UBC Okanagan – Finance Operations (ADM006 – 1138 Alumni Avenue, Kelowna, BC V1V 1V7)
Revised Aug. 10, 2016
Page 2 of 2