Expense Disclosure Reporting Form

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Date of expense Destination Purpose Airfare Other Transportation AccommodationMeals (includes per

diem allowances)Seminar / Conference /

Registration fees Total

1 13-Jun-19 YellowknifeTo attend AWCBC Governance Summit $60.36 $582.75 $96.00 $739.11

2 25-Jun-19 EdmontonTo attend Board Committee and Board Meetings $105.00 $29.35 $11.00 $145.35

3 $0.004 $0.005 $0.006 $0.007 $0.008 $0.009 $0.00

10 $0.00

$884.46

Dates Total1 $0.002 $0.003 $0.004 $0.005 $0.006 $0.007 $0.008 $0.009 $0.00

10 $0.00$0.00

$884.46

Notes

Travel, Seminars/Conference and Associated Expenditures

Travel Related

Name: For the Period: Jun-19Ivana Niblett, Board Member

Non-travel related Expenditures (Business meals, etc…)Purpose

Notes

Total claimed for reporting period:

Non-Travel Related

Expense Disclosure Reporting Form

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Mileage & Per Diem Allowances

Employee Name Expense TypeSubmitted

Date Trip InfoTrip Start

DateTrip End

DateExpense

Trans Date Detail DescriptionTotal Amount

(Includes GST/HST)Summary Item

Reference

Ivanna Niblett Travel Meal Allowance 6/28/2019

01. 06/10/2019 at 01:00 PM to 06/13/2019 at 11:15 PM - Yellownknife [OoP] Northwest Territories [C/S] ~ AWCBC Governance Summit June 10-13 2019 6/10/2019 6/13/2019 6/13/2019

3 day Per Diem allowance, Dinner on June 10, 11 & 13 $96.00 1

Ivanna Niblett Travel Meal Allowance 6/28/2019

02. 06/25/2019 at 05:00 AM to 06/25/2019 at 05:00 PM - Edmonton ~ June 25th WCB Board of Directors meeting 6/25/2019 6/25/2019 6/25/2019

1 breakfast meal allowance while enroute to Edmonton for Board meeting $11.00 2

GST 833 250210 RT0001

Park2Go Value Valet Calgary 2121 100 AVENUE NE Calgary, AB T3J 3N5 403-532-4844

Ticket # Park2Go Ticket Terminal DReservation # Rate 6 - Other Discount/Coupon ratOpen Date 06/10/19 14:09Close Date 06/13/19 22:17Timespan 3 dys, 8 hrs, 8 mins

Cashier ID 2204Date 06/13/19 22:17Customer 134107Name NIBLETT, IVANAVehicle License Lot Location

PARKING CHARGES Days 4 $ 59.81Discount - WESTJET CUSTOM 15.000% $ 8.97-Tip Valet 1 $ 5.00Subtotal $ 55.84Airport Access Fee $1.880 flat $ 1.88GST 5.000% $ 2.64 -------Parking Total $ 60.36

Grand Total $ 60.36

PAYMENTS 06/13/19 22:17 $ 60.36 TTID: Auth: Batch: 48

Tip Valet + ________________

Total = ________________

X_____________________________________________

Thank you for your business!

Electronic Miscellaneous Document (EMD) ReceiptPrepared ForNIBLETT/IVANA MS

RESERVATION CODE

ISSUE DATE 25Jun2019

DOCUMENT NUMBER

ISSUING AIRLINE WESTJET

ISSUING AGENT WestJet/MK7

Electronic Miscellaneous Document / Other Charges

Reaso n fo r Issuance Descript io n/Co de LAT E SHOW ECONO / D

Airline Designat o r WS

Co upo n Base Fare CAD 100.00

Payment Details

Tax/Fee/Charge CAD 5.00

To t al EMD Amo unt CAD 105.00

Fo rm o f Payment CREDIT CARD -

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