Free Missing Receipt Form
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For receipts you issue for your own business or property. Never create a receipt on behalf of a business you don't own, or for a payment that didn't happen — see our Terms.
What Is a Missing Receipt Form?
A missing receipt form (also called a lost receipt declaration or missing receipt affidavit) is a signed statement an employee gives with an expense report when the original receipt is lost, damaged or was never issued. It records the same details the receipt would have shown, explains why the receipt is missing, and lets a manager approve the claim.
It is meant for expenses you really paid. It is not a replacement receipt from the merchant, and it should never be used for an expense you did not make.
What to Include
- Your name and department, so finance can match it to your expense report.
- The vendor or merchant you paid, and where.
- The date and amount of each expense, listed separately.
- The business purpose: who it was for and why.
- Why the receipt is missing: lost, damaged, never issued, or not available (parking meters, tips).
- Your signature and your manager’s approval.
Attach any other proof you have, such as a card or bank statement line, a booking confirmation or an email from the vendor. The IRS says that when records are incomplete, you prove an expense with your own written statement plus other supporting evidence (IRS Publication 463, “What if I have incomplete records?”).
How to Fill It In
- Enter your name, your company and today’s date.
- Add the vendor, the date of the expense, the business purpose and the reason the receipt is missing.
- Add one line per lost expense with its amount. The total is calculated for you.
- Keep the declaration ticked, download the PDF, sign it and ask your manager to sign it.
Before You Use One
Read your company’s expense policy first. Many policies cap how often a missing receipt form can be used, set a maximum amount, or ask for the vendor’s duplicate receipt first. If the merchant can reprint or email a copy of the receipt, that is always the better option.
Missing Receipt Form FAQ
Can I get reimbursed without a receipt?
Often yes. Most employers accept a signed missing receipt declaration with a manager’s approval, especially when you can attach a card or bank statement showing the charge. Some policies limit how often or how much you can claim this way.
Is a missing receipt form the same as a fake receipt?
No. A missing receipt form is your own signed statement that you paid an expense whose receipt you no longer have. Creating a receipt that looks like it came from the merchant is not allowed and can be fraud.
Can I list several lost receipts on one form?
Yes. Add one line per expense with its own description and amount. If the expenses were on different dates or with different vendors, note them in each line’s description.
Lost Receipt Form, Affidavit or Declaration?
Companies call it a lost receipt form, a missing receipt declaration or a lost receipt affidavit. For an expense report they mean the same: a signed statement of the vendor, date, amount, business purpose and why the receipt is missing. An affidavit in the strict sense is sworn before a notary; most employers only need the signed declaration this page makes. Check your expense policy, and attach a bank or card statement line if you have one.
More Questions
Can I use this for a lost receipt on an expense report?
Yes, that is what it is for. Fill in one line per missing receipt (a fuel stop, a taxi, a meal), sign it, and attach it to the expense report with any card statement that shows the charge.
What if I lost several gas receipts?
List each fill-up as its own line with the date, station, amount and trip. A mileage log or card statement for the same dates makes the declaration much stronger.