Staff Reimbursement Form - Chai Lifeline Canada

Reimbursement Form

Gas Mileage Form

Reimbursement Form

Staff Information
Region*
Name*
First Last
Email*
Address*
Street Address Address Line 2 City Province Postal Code
What Program Are You Being Reimbursed For?*
Please select from the drop down below. Failure to select could result in your reimbursement not being paid.
Receipt Information
Please note failure to submit all receipts and images of receipts will be treated as an incomplete submission and your reimbursement will not be processed.
Receipts*
Chai Lifeline Client/Name of Event Name of Store Receipt is From How much did you spend? Date of Receipt

Please be specific with details. Thank you!
Upload all receipts here*
Drop files here or

Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 256 MB.
Total amount for reimbursement*
Notes

Gas Mileage Form

Gas Mileage Form
Rate $0.45/km
Are you:*
Chai Lifeline Canada Branch?
- Toronto
- Montreal
Name*
First Last
Address*
Street Address Address Line 2 City Province Postal Code
Email*
Phone*
Gas Mileage Details
Add here:*
Client/Program To From KM Date
Total KM*
Total $*
Additional Notes: Please include info ie. Who you saw, where you went, for what reason. TY*

Toronto

300A Wilson Ave.
Toronto, Ontario, M3H 1S8
Phone: 647.430.5933
Fax: 416.628.1597

Montreal

4900 Jean Talon Ouest, #220 Montreal, Quebec H4P 1W9
Phone: 514.667.7041

Crisis Intervention

1 (800) 556-6238
[email protected]

Newsletter subscription

At Chai Lifeline Canada we are passionately devoted to alleviating the burden of those facing medical challenge. From the moment of diagnosis, through the arduous months and years, in good times and bad, Canadian families have discovered that Chai Lifeline Canada is a friend for life.

Chai Lifeline Canada. Fighting Illness with Love.

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Privacy Policy

Chai Lifeline Canada is a registered Canadian charity
Reg. No. 85656 5536 RR0001

Chai Lifeline Canada is a member of the OCGA

©2025 Chai Lifeline Canada. All rights reserved. Design & Development by LeverageIT. Chai Lifeline Canada is a registered Canadian charity. Reg. No. 85656 5536 RR0001. Chai Lifeline Canada is a member of the OCGA

About us

DELIVERING JOY & HOPE TO CHILDREN AND FAMILIES IMPACTED BY ILLNESS & CRISIS

HOW YOU CAN HELP

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Staff Information

Receipt Information

Gas Mileage Form

Gas Mileage Details

36 HOURS.

$500,000

2X MATCH!

Minimum $18 donation per tribute card

Chai Lifeline Client/Name of Event	Name of Store Receipt is From	How much did you spend?	Date of Receipt

Client/Program	To	From	KM	Date