Travel Attestation Form

Travel Attestation Form

RECITALS

WHEREAS, Client Name: (the "Organization") engages employees, contractors, or agents to travel for operational purposes; and

WHEREAS, Traveler Name: (the "Traveler") will undertake travel under the terms of this Travel Attestation Form in accordance with the Organization's travel policies and applicable law;

WHEREAS, the parties desire to document the scope, responsibilities, health and safety attestations, reimbursement arrangements, and legal terms that govern the travel described below.

SCOPE OF TRAVEL

TRAVEL DETAILS

Destination: | Additional Destinations:

Departure Date:    Return Date:

HEALTH, SAFETY & ATTESTATIONS

By checking each box and signing below, the Traveler certifies the following statements are true and complete to the best of their knowledge and that providing false information may result in disciplinary action or civil remedies.

I am currently free of symptoms consistent with communicable illnesses that would impair my ability to travel or require isolation.

I have complied with any required testing or vaccination policy of the Organization applicable to this travel and will provide proof upon request.

I will comply with applicable quarantine, isolation, or public health measures at origin, destination, and upon return as required by law or Organization policy.

I accept personal responsibility for my conduct during travel and acknowledge the Organization may not be liable for my personal actions except as required by law.

PAYMENT / REIMBURSEMENT TERMS

Reimbursement Amount:

Payment Schedule (describe timing and conditions):

Late Payment Fee:

Reimbursements are subject to submission of itemized receipts and compliance with Organization travel policy. The Organization reserves the right to deny reimbursement for expenses that are not reasonable, customary, or documented.

TERM AND TERMINATION

Effective Start Date:    Effective End Date:

Termination: Either party may terminate this travel arrangement for convenience by delivering written notice to the other party at least days prior to the intended termination date. Termination does not relieve either party of obligations accrued prior to the effective termination date.

CONFIDENTIALITY

The Traveler acknowledges that in the course of travel they may have access to confidential or proprietary information of the Organization or its clients. The Traveler agrees to maintain the confidentiality of such information and not to disclose or use it except as necessary for the performance of authorized duties, and in accordance with any separate confidentiality agreement in effect between the parties.

GOVERNING LAW & ENTIRE AGREEMENT

Governing Law: This Travel Attestation Form shall be governed by and construed in accordance with the laws of the State/Province identified by the Organization, without regard to conflict of law principles. Governing jurisdiction: courts of the selected venue shall have exclusive jurisdiction for disputes.

Entire Agreement: This document constitutes the entire agreement between the parties with respect to the subject matter herein and supersedes all prior understandings and agreements, whether written or oral, relating to such subject matter. Any modification must be in writing and signed by both parties.

EMERGENCY CONTACT

CERTIFICATION AND ACKNOWLEDGMENT

The undersigned Traveler certifies under penalty of perjury and acknowledges that they have read and understand this Travel Attestation Form, that the information provided herein is true and correct, and that they will comply with all applicable Organization policies, public health directives, and laws. The Traveler further authorizes the Organization to take reasonable actions to ensure compliance and to seek medical attention if necessary.

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