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Reimbursement Form

  • Staff Information

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  • 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.
  • Chai Lifeline Client/Name of EventName of Store Receipt is FromHow much did you spend?Date of Receipt 
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    Gas Mileage Form

    • Gas Mileage Form

      Rate $0.45/km
    • Gas Mileage Details

    • ToFromKMDate 

    Toronto

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

    Montreal

    1090B Pratt
    Montreal, Quebec, H2V 2V2
    Phone: 514.667.7041

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

    Chai Lifeline Canada is a member of the OCGA

    ©2020 Chai Lifeline Canada. All rights reserved. Design & Development by LeverageIT

    ©2023 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
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    • About Us
      • Who We Are
      • Our Values
      • Our Team
      • Contact Us
    • What We Do
      • What We Do
      • News and Media
        • Videos
    • How You Can Help
      • Annual Campaign
      • Birthday in a Box
      • Clothing Bin Program
      • Donate a Car
      • Ecards
      • Hair Donation Program
      • Start Your Own Fundraiser
        • Bnei Mitzvah Program
        • Party With A Purpose
        • Stand for Chai
      • Toy Drive & Chanukah Heroes
        • Amazon Wish List
      • Young Builders
    • Family Resources
      • Autism Resources
      • Bereavement & Counselling Support
      • Chronic Illness Resources
      • Financial Resources
      • Kids’ Lifeline
      • Mental Health Resources
      • Chai Lifeline Forms and Applications
    • Careers & Volunteers
      • Employment Opportunities
      • Volunteer Hub
        • Volunteer Forms

    Toronto

    300A Wilson Ave. Toronto, Ontario, M3H 1S8

    Phone: 647.430.5933

    Montreal

    1090B Pratt. Montreal, Quebec, H2V 2V2

    Phone: 514.667.7041

    Crisis Intervention

    Email: [email protected]

    Phone: 1 (800) 556-6238

    • About Us
      • Who We Are
      • Our Values
      • Our Team
      • Contact Us
    • What We Do
      • What We Do
      • News and Media
        • Videos
    • How You Can Help
      • Annual Campaign
      • Birthday in a Box
      • Clothing Bin Program
      • Donate a Car
      • Ecards
      • Hair Donation Program
      • Start Your Own Fundraiser
        • Bnei Mitzvah Program
        • Party With A Purpose
        • Stand for Chai
      • Toy Drive & Chanukah Heroes
        • Amazon Wish List
      • Young Builders
    • Family Resources
      • Autism Resources
      • Bereavement & Counselling Support
      • Chronic Illness Resources
      • Financial Resources
      • Kids’ Lifeline
      • Mental Health Resources
      • Chai Lifeline Forms and Applications
    • Careers & Volunteers
      • Employment Opportunities
      • Volunteer Hub
        • Volunteer Forms
    Menu
    • About Us
      • Who We Are
      • Our Values
      • Our Team
      • Contact Us
    • What We Do
      • What We Do
      • News and Media
        • Videos
    • How You Can Help
      • Annual Campaign
      • Birthday in a Box
      • Clothing Bin Program
      • Donate a Car
      • Ecards
      • Hair Donation Program
      • Start Your Own Fundraiser
        • Bnei Mitzvah Program
        • Party With A Purpose
        • Stand for Chai
      • Toy Drive & Chanukah Heroes
        • Amazon Wish List
      • Young Builders
    • Family Resources
      • Autism Resources
      • Bereavement & Counselling Support
      • Chronic Illness Resources
      • Financial Resources
      • Kids’ Lifeline
      • Mental Health Resources
      • Chai Lifeline Forms and Applications
    • Careers & Volunteers
      • Employment Opportunities
      • Volunteer Hub
        • Volunteer Forms

    Toronto

    300A Wilson Ave. Toronto, Ontario, M3H 1S8

    Phone: 647.430.5933

    Montreal

    1090B Pratt. Montreal, Quebec, H2V 2V2

    Phone: 514.667.7041

    Crisis Intervention

    Email: [email protected]

    Phone: 1 (800) 556-6238