Can this form be signed electronically?

Yes. Electronic signatures are generally legally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided intent and consent are documented and the record can be retained.

Is notarization required?

Not ordinarily unless employer policy or a specific regulatory need demands a sworn affidavit. If required, follow local notary or RON requirements and retain the notarial certificate.

What supporting documents are acceptable?

Bank or credit card statement excerpts showing the transaction, vendor reprints, order confirmations, or emailed receipts are typical; include items that clearly match vendor, date, and amount.

What if I cannot obtain any substitute proof?

Provide a detailed affidavit explaining attempts to obtain the receipt. Employers may request additional verification or decline reimbursement depending on policy and risk assessment.

Can remote online notarization be used?

Possibly. Many states permit RON with identity proofing and recorded audio-video; check state notary rules and employer acceptance before relying on RON.

Who should approve the claim?

An authorized approver in accounts payable or the claimant’s manager should review attachments and sign to certify business purpose and allow reimbursement.

Electronic Signature
Templates
Finance
Expense Lost Receipt

Expense Lost Receipt

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

EXPENSE LOST RECEIPT

Use this form to request reimbursement when original receipts have been lost or destroyed. Complete all fields, attach available supporting documentation, and obtain required approvals. Submission of a false or fraudulent claim may result in disciplinary action, repayment of funds, and legal consequences.

Employee Information

Company / Organization Employee Name

Employee ID

Department

Email

Phone

Report Reference

Expense Report No.:

Date Submitted:

Itemized Expenses (for which receipt is lost)

Complete each line for expenses without receipts. Provide supporting documentation where available (card statement, bank record, email confirmations).

Expense Date	Vendor / Merchant	Business Purpose / Description	Category	Amount

Subtotal

Tax / VAT

Other (fees, shipping)

Total Reimbursable

Reason for Lost Receipt & Supporting Documentation

Reason the original receipt is not available

Supporting evidence provided (check all that apply)

Credit / debit card statement showing charge

Bank statement showing payment

Email confirmation or invoice copy from vendor

Other (explain)

Attestation

I certify that the expenses claimed above were incurred by me on behalf of the company for legitimate business purposes. I further certify that the original receipts were lost or destroyed despite reasonable efforts to retain them. I understand that reimbursement is subject to company policy and verification; if documentation or verification cannot substantiate the claim, reimbursement may be reduced or denied. I understand that intentional misrepresentation or falsification of expense claims may result in disciplinary action, repayment, and legal prosecution.

I agree to cooperate with any follow-up requests from Finance and to provide additional evidence if available. By signing below I confirm the accuracy of this declaration under penalty of disciplinary action.

Manager Review (for department use)

Manager Name

Manager Email

Date Reviewed

Approved for reimbursement

Approved Amount

Manager Comments

Accounting Use Only

Processed By

Date Processed

GL / Account Code

Reimbursement Method

Payroll (next pay cycle)

Check issued

Other

Check Number (if applicable)

Employee Name:

By:

Date:

What an Expense Lost Receipt Is and when it applies

An Expense Lost Receipt is a written declaration used when an original sales or expense receipt is unavailable but reimbursement or tax substantiation is required. It documents transaction details (date, vendor, amount, purpose), explains why the original is missing, and attaches substitute proof such as credit card statements, bank records, or vendor reprints. Employers, contractors, and finance teams commonly accept a completed lost-receipt form together with supporting records to permit reimbursement, process expense reports, or substantiate business deductions for tax purposes.

Why you might use an Expense Lost Receipt

An Expense Lost Receipt preserves a consistent audit trail, enables timely reimbursement, and documents reasonable efforts to obtain the original receipt. Properly completed forms reduce rejection, support tax reporting, and provide evidence for internal or external reviews under ESIGN and recordkeeping rules.

Who typically completes or receives this form

The completed form and supporting documents are retained by the payer or employer per recordkeeping rules and by the claimant for tax and audit purposes.

Employees submitting expense reimbursements to corporate finance or accounts payable.
Independent contractors documenting business deductions for tax records.
Accounts payable or expense auditors verifying claims during review.

Step-by-step: complete and submit the Expense Lost Receipt

Follow these sequential steps to produce a defensible record for finance and tax purposes.

01

Prepare Form: Complete all required fields and sign where indicated.
02

Attach Proof: Include bank/credit card statements or vendor reprints showing the charge.
03

Authenticate: Add signature and date; notarize if employer policy requires it.
04

Submit: Send to accounts payable or upload to the expense system with tracking.

Essential parts of a professional Expense Lost Receipt

A clear structure speeds review and supports auditability. Include these six elements on every form.

Claimant Info

Full name, employee or contractor ID, department, and contact details so reviewers can confirm origin and follow up if needed.

Transaction Details

Vendor name, transaction date, exact dollar amount, and method of payment to map the claim to bank or card records.

Business Purpose

Concise justification linking the expense to company business, client name if applicable, and project or cost center.

Supporting Evidence

Scanned bank or card statements, vendor reprints, online order confirmations, or screenshots showing merchant, date, and amount.

Affidavit Statement

A signed declaration explaining why the original receipt is lost and affirming accuracy under penalty of company policy or law.

Authorization

Approver signature, title, and date indicating the claim was reviewed and approved for reimbursement.

Data fields that must be present on the form

Name: Claimant full name

Date: Expense date MM/DD/YYYY

Vendor: Merchant or payee name

Amount: Exact dollar amount

Reason: Business purpose description

Signature: Signed and dated by claimant

How to configure an online lost-receipt workflow

Set fields, attachments, and authentication to match your approval and audit requirements.

Field	Configuration
Authentication	Email link or SMS code; add stronger checks for high-value claims
Template	Use a reusable template with required fields and attachments enforced
Attachments	Require upload of statement or vendor reprint before submission
Audit Trail	Enable timestamps, IP logging, and signer metadata retention

Digital signing and eSubmission basics

Use an eSignature solution that preserves metadata and stores completed records in a compliant repository for the required retention period.

File formats: PDF, DOCX supported
Integrations: Connectors to ERP and storage
Security: TLS and AES-256 encryption

Typical online flow for a lost-receipt claim

A consistent electronic flow reduces manual handling and preserves an auditable trail from submission through approval.

Prepare Document: Populate template and attach substitutes
Place Signature: Add claimant and approver signature fields
Signer Authenticates: Email link, SMS code, or stronger method
Store Evidence: Save signed copy and audit log in repository

Typical timing for submission and processing

Deadlines often depend on employer policy and tax reporting needs; follow organizational rules and retain copies per law.

Employer Claim Window:

Commonly 30–90 days from expense; consult internal policy

Payroll Cutoffs:

Submit before payroll close to appear in the same reimbursement cycle

Tax Documentation:

Retain records at least three years for IRS purposes (see IRC §6501(a))

Notarization Timing:

Complete notarization before submitting if policy requires

Audit Holds:

Keep copies until audit resolution or retention period ends

Common mistakes that delay or invalidate claims

Incomplete fields or missing signature cause automatic returns to claimant
Claimant name mismatches with payroll or ID prevent verification
Insufficient substitute documents fail to prove the transaction
Late submission outside employer window may be denied

Risks from incorrect or fraudulent lost-receipt statements

Reimbursement Denial: Claim may be rejected without adequate proof

Tax Consequences: Incorrect substantiation can affect deductions

Disciplinary Action: Employer sanctions for falsified claims

Refund Adjustment: Tax filings may require amendment

Audit Exposure: Insufficient support increases audit risk

Perjury Risk: False sworn statements can lead to legal penalties

Practical examples of lost-receipt scenarios

Two concise scenarios show how a completed form and attachments resolve common issues for finance teams and auditors.

Field Sales Claim

A traveling rep lost a client dinner receipt and completed the form describing the meal and attendees

Attached credit-card statement showing the merchant and amount
The finance team approved after verifying the card transaction and recorded the reimbursement with supporting audit notes.

Remote Contractor

A remote contractor could not obtain a vendor reprint and submitted an affidavit plus a bank statement

Contractor provided project code and invoice number
Accounts payable accepted the affidavit, reimbursed the expense, and retained the packet for tax substantiation.

eSignature platform comparison for processing the Expense Lost Receipt

Compare common vendor options for electronic completion and signing. signNow appears first per standard vendor ordering.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial, no credit card	Varies by plan	Varies by plan	Yes, limited	Yes, limited
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Common questions and answers about Expense Lost Receipts

Answers address e-signatures, notarization, acceptable evidence, and practical next steps for claimants and reviewers.

Need help? Contact support

Can this form be signed electronically?
Yes. Electronic signatures are generally legally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided intent and consent are documented and the record can be retained.
Is notarization required?
Not ordinarily unless employer policy or a specific regulatory need demands a sworn affidavit. If required, follow local notary or RON requirements and retain the notarial certificate.
What supporting documents are acceptable?
Bank or credit card statement excerpts showing the transaction, vendor reprints, order confirmations, or emailed receipts are typical; include items that clearly match vendor, date, and amount.
What if I cannot obtain any substitute proof?
Provide a detailed affidavit explaining attempts to obtain the receipt. Employers may request additional verification or decline reimbursement depending on policy and risk assessment.
Can remote online notarization be used?
Possibly. Many states permit RON with identity proofing and recorded audio-video; check state notary rules and employer acceptance before relying on RON.
Who should approve the claim?
An authorized approver in accounts payable or the claimant’s manager should review attachments and sign to certify business purpose and allow reimbursement.

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now