Document : F-Temp-12

Date : 07/09/2005 (j/m/a)

Révision : B
Title : EXPENSE REPORT

GENERAL INFORMATION
Please fill out blue sections

Name: Maryse Milton

Travelling Period: From: 5/28/2007 To: 5/29/2007

Company Name: DentaPlus

Location (city and country): Montreal, Quebec

Reason for travelling: Journee Dentaire du Quebec

EXPENSE CALCULATION
Please fill out blue sections

Money Advance Excess Cash Withdrawal

(please indicate the amount of cash you give to Cynovad)

In Canadian Currency: 0.00 In Canadian Currency: 0.00

In American Currency: 0.00 In American Currency: 0.00
In Euro Currency: 0.00 In Euro Currency: 0.00
In Another Currency: 0.00 In Another Currency: 0.00
Which one? Other Currency Which one? Other Currency

Using your Vehicle for Business Purposes

Cynovad pays $0.45 per kilometer travelled
Total of kilometers: 0
Cynovad will pay you: 0.00

Exchange Rate Calculation

Foreign Currency Purchasing
(please indicate the amount of foreign currency purchased)
Total cost of foreign currencies purchased in CAN$:

In American Currency: 1.00 American Currency: 1.00

In Euro Currency: 1.00 Euro Currency: 1.00
In Another Currency: 1.00 Other: Other Currency 1.00
Which one? Other Currency

Exchange Rate for American Currency: 1 US dollar = x $ Canadian 1.00

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Exchange Rate for Euro Currency: 1 Euro = x $ Canadian 1.00
Exchange Rate for Another Foreign Currency: 1 Foreign unit = x $ Canadian 1.00

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CYNOVAD $ Canadian 11/02/2021

CURRENCY: CAN$ Canadian

OTHER
DATE COMMENTS FLY TICKET CAR
TRANSPORTATION
RESTAURANT HOTEL MISCELLANEOUS

28/05/07 Parking Congres 15.00

28/05/07 Lunch 8.90
29/05/07 Parking Congres 15.00
29/05/07 Lunch 8.14
29/05/07 Dinner 23.55

TOTAL 0.00 0.00 30.00 40.59 0.00 0.00

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CYNOVAD $ American 11/02/2021

CURRENCY: US$ American

OTHER
DATE COMMENTS FLY TICKET CAR
TRANSPORTATION
RESTAURANT HOTEL MISCELLANEOUS

TOTAL 0.00 0.00 0.00 0.00 0.00 0.00

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CYNOVAD Euro 11/02/2021

CURRENCY: Euro
OTHER
DATE COMMENTS FLY TICKET CAR
TRANSPORTATION
RESTAURANT HOTEL MISCELLANEOUS

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CYNOVAD Euro 11/02/2021

TOTAL 0.00 0.00 0.00 0.00 0.00 0.00

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CYNOVAD Other 11/02/2021

CURRENCY: Other Currency

OTHER
DATE COMMENTS FLY TICKET CAR
TRANSPORTATION
RESTAURANT HOTEL MISCELLANEOUS

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CYNOVAD Other 11/02/2021

TOTAL 0.00 0.00 0.00 0.00 0.00 0.00

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 EXPENSE STATEMENT

Name: Maryse Milton

Travelling Period: From: 5/28/2007 To: 5/29/2007
Company Name: DentaPlus
Location (city and country): Montreal, Quebec
Reason for travelling: Journee Dentaire du Quebec

CAN$ US$ EUR Other Currency

EXCHANGE RATES 1.0000 1.0000 1.0000 1.0000

EXPENSES CAN$ US$ EUR Other Currency TOTAL CAN$

FLY TICKET 0.00 0.00 0.00 0.00 0.00

CAR 0.00 0.00 0.00 0.00 0.00
OTHER TRANSPORTATION 30.00 0.00 0.00 0.00 30.00
RESTAURANT 40.59 0.00 0.00 0.00 40.59
HOTEL 0.00 0.00 0.00 0.00 0.00
MISCELLANEOUS 0.00 0.00 0.00 0.00 0.00

TOTAL EXPENSES 70.59 0.00 0.00 0.00 70.59

CAN$ US$ EUR Other Currency TOTAL CAN$

Money Advance 0.00 0.00 0.00 0.00 0.00

Excess Cash Withdrawal 0.00 0.00 0.00 0.00 0.00

TOTAL EXPENSES 70.59 0.00 0.00 0.00 70.59

BALANCE -70.59 0.00 0.00 0.00 -70.59

BALANCE RECEIVABLE BY
70.59 CAN$
EMPLOYEE:
BALANCE PAYABLE TO
0.00 CAN$
CYNOVAD:

SIGNATURE DATE

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