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Mileage reimbursement form template

Claim travel in your own vehicle with a trip log.

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How to make a mileage reimbursement form

  1. 1

    Check the questions: rename, add or delete any field, or change how it’s answered.

  2. 2

    Add your organisation’s name, a contact line and your logo if you like.

  3. 3

    Choose fillable PDF, printable PDF, Word or HTML, and the paper size.

  4. 4

    Download the mileage reimbursement form and share it, print it or add it to your website.

About this mileage reimbursement form

When employees use their own car or two-wheeler for work, they’re usually paid a fixed rate per kilometre or mile. A mileage form logs each trip (date, start and end points, purpose, odometer readings and distance) and multiplies the total by the agreed rate.

A careful log is also what tax authorities expect if mileage is claimed as a business expense. Estimate fuel costs separately with the fuel cost calculator.

What’s on the mileage reimbursement form

The template has 4 sections and 14 questions. Every one can be renamed, moved or deleted.

  • Claimant: Name; Employee ID; Vehicle (choose one: Car, Two-wheeler); Registration number; Period from; to
  • Trip log: Trips table (Date, From, To, Purpose, Odometer start, Odometer end, Distance)
  • Claim: Total distance; Rate per km or mile; Total claim; Claimant signature with date
  • Approval: Decision (choose one: Approved, Not approved); Approved by; Approver signature with date

Tips

  • Record the odometer at the start and end of each trip, not just the distance.
  • Don’t claim your normal commute from home to the office.
  • Write the rate per km or mile set by your company policy.

Four ways to save it

A fillable PDF has typing boxes, tick boxes and choices built in. A printable PDF gives clean boxes and writing lines for pen and paper. The Word file can be edited further, and the HTML code adds the same questions to a website. Browse more form templates, or design a completely different layout in the custom form builder.

Frequently asked questions

What rate should I use?

Use your employer’s policy rate. In some countries the tax authority publishes a standard rate per mile or kilometre.

Can I log a whole month on one form?

Yes. The trip log fills the table; print a second page for more trips.

Can I get the mileage reimbursement form as a Word document?

Yes. Choose “Word” under “Save as” to download a .docx file you can keep editing in Microsoft Word, Google Docs or LibreOffice.

Can I change the questions on the mileage reimbursement form?

Yes. Rename any question, change its answer type (short answer, tick boxes, rating, table and more), move it, or delete it. You can also add whole new sections.

Can I put the mileage reimbursement form on my website?

Yes. Choose “HTML” to copy ready-made form code with labels and a simple style. Set the form’s action to the address that should receive submissions, such as your own form handler.

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