Mileage Log

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

Mileage Log for {{month}} {{year}}

Employee Name: {{employee_name}}

Employee ID: {{employee_id}}

Department: {{department}}

Vehicle Make & Model: {{vehicle_make_model}}

Vehicle Registration Number: {{vehicle_registration_number}}

Starting Odometer Reading (beginning of month): {{start_odometer}}

Mileage Details

Please record all business-related travel in the table below. Ensure all fields are accurately completed.

| Date | Time (Departure) | Time (Arrival) | Odometer (Start) | Odometer (End) | Total Distance (km) | Origin | Destination | Purpose of Journey | Notes / Client |

|--------------|------------------|----------------|------------------|----------------|---------------------|-------------------------|-------------------------|--------------------------------------------------|------------------------------------------|

| {{date_1}} | {{time_dep_1}} | {{time_arr_1}} | {{odo_start_1}} | {{odo_end_1}} | {{distance_1}} | {{origin_1}} | {{destination_1}} | {{purpose_1}} | {{notes_1}} |

| {{date_2}} | {{time_dep_2}} | {{time_arr_2}} | {{odo_start_2}} | {{odo_end_2}} | {{distance_2}} | {{origin_2}} | {{destination_2}} | {{purpose_2}} | {{notes_2}} |

| {{date_3}} | {{time_dep_3}} | {{time_arr_3}} | {{odo_start_3}} | {{odo_end_3}} | {{distance_3}} | {{origin_3}} | {{destination_3}} | {{purpose_3}} | {{notes_3}} |

| {{date_4}} | {{time_dep_4}} | {{time_arr_4}} | {{odo_start_4}} | {{odo_end_4}} | {{distance_4}} | {{origin_4}} | {{destination_4}} | {{purpose_4}} | {{notes_4}} |

| {{date_5}} | {{time_dep_5}} | {{time_arr_5}} | {{odo_start_5}} | {{odo_end_5}} | {{distance_5}} | {{origin_5}} | {{destination_5}} | {{purpose_5}} | {{notes_5}} |

Monthly Summary

Ending Odometer Reading (end of month): {{end_odometer}}

Total Business Kilometres for the Month: {{total_business_km}}

Total Private Kilometres for the Month: {{total_private_km}}

Total Kilometres for the Month: {{total_km_month}}

Reimbursement Rate per Kilometre: {{reimbursement_rate}}

Total Reimbursement Amount Due: {{total_reimbursement_due}}

Declaration

I, {{employee_name}}, declare that the information provided in this mileage log is true and accurate to the best of my knowledge. All mileage recorded herein was incurred for legitimate business purposes.

I understand that any false declaration may result in disciplinary action and/or repayment of any falsely claimed amounts.

Approval (for Management Use Only)

Approved by: _________________________

Printed Name: {{approver_name}}

Position: {{approver_position}}

Date of Approval: {{approval_date}}

Signature Block

_________________________ _________________________

Employee Signature Date

_________________________

Manager/Supervisor Signature

{{manager_name}}

{{manager_title}}