Free reimbursement forms

Employee Mileage Reimbursement Form

What an employee mileage reimbursement form asks for, how a claim gets approved, and what has to be attached. The blank files and the filled example are one click away.

For 2026, the US benchmark is 72.5 cents per mile from January to June and 76 cents per mile from July 1. The form uses the rate your employer's policy sets. Check the 2026 IRS rate.

See the filled sample

Free, no account · 9 trip columns · 12 rows on the printable sheet · 60 rows in the Excel workbook

Guide by MileagePilotUpdated Nov 3, 2026
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Blank form · 12 trip rows · landscape page

What the form asks for

A reimbursement form needs more than a list of miles. Payroll matches the claim to a person and a period. A reviewer checks each trip and its rate. Both need a dated approval. The blank form groups its fields into these four sections.

Who is claiming, and when

Employee nameEmployee IDDepartment / cost centerCompany / employerClaim periodDate submitted

Payroll matches the claim to a person, a cost center and a pay period. The submission date shows whether the claim arrived inside the employer's window. The employee ID keeps two people with the same name apart.

The rate and the evidence

Distance unitRate basisVehicle / plateMileage log attached

A distance without a unit or a rate source is not a figure anyone can check. The rate basis records the policy or official rate behind the amount. The mileage log field tells a reviewer whether the evidence is attached.

What was driven

Trip datePurposeStartDestinationDistanceRateAmount

Record one row per trip. Each row shows when, why, from where, to where, how far, at what rate, and the amount. The rate belongs on the row because it can change during the year. The amount is the figure a reviewer checks against it.

What payroll needs to approve

ApprovalNotesCertificationDual signatures

The approval column shows a per-trip status or initials where the process needs one. Use Notes for parking, tolls or a policy exception. The certification and the two dated signatures record that the claim is for business mileage.

The blank form is 9 columns wide and 12 rows long on paper. The Excel workbook has 60 rows ready to fill. The sample rows below use the same columns, so you can trace every figure on the filled example back to a field the blank form prints.

Blank form or filled sample

The blank form is the file you fill in. The sample is a reference: 5 fictional trips, two 2026 rates, a calculated total and a signed approval. Both downloads use the same nine trip columns. The table below puts the route in one cell and leaves approval and notes to the sample sheet so the rows fit on a phone.

Blank form

Start with a blank form for a real claim. Each of the three files carries the same claim header, trip columns and totals row; which one to take is a question about how you will fill it in, and you can see all three in full before you download one.

  • All three carry the same claim header, the nine trip columns and a totals row with a cell for the total distance and the total reimbursement.
  • What changes between them is how you fill the claim in, not what it asks for.

Filled sample

Fictional example

The sample has 5 trips across the July 1 rate change, a total of 134.0 mi · $98.97, the certification and both signatures. Use it to check field order or to train an approver before the first real claim.

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The certification on the form reads "I certify that these trips were for business, that commuting and personal miles are excluded, and that the distances are accurate."

The sample employee, company, vehicle and trips are fictional. Replace them with your own records before the form goes to payroll.

How to fill one line

Price the line, then total the lines. The rate belongs on the row because it can change during the year. A claim that crosses July 1 needs both figures.

Trip datePurposeRouteDistanceRateAmount
2026-04-03Client meetingAustin HQ → Cedar Park34.0 mi72.5¢$24.65
2026-04-08Site visitAustin HQ → Round Rock18.0 mi72.5¢$13.05
2026-04-14Supply pickupAustin HQ → San Marcos30.0 mi72.5¢$21.75
2026-08-06Client meetingAustin HQ → Cedar Park34.0 mi76¢$25.84
2026-08-12Site visitAustin HQ → Round Rock18.0 mi76¢$13.68

Rate per mile. The sample uses the 2026 IRS business rate: 72.5 cents January to June and 76 cents from July 1.

January-June rate

34.0 mi × $0.725 = $24.65

The first-half row uses 72.5¢ per mile.

July-December rate

34.0 mi × $0.760 = $25.84

The second-half row uses 76¢ per mile.

Claim total

134.0 mi · $98.97

The total is the sum of the lines, not a second calculation from one rate.

  • Write the route as well as the client. A start and a destination make the trip checkable.
  • Put the rate in force on the trip date in that row. In the US, 2026 has two business rates, so a claim that crosses July 1 needs both.
  • Keep one distance unit on the form. A total that adds miles to kilometres is not a figure payroll can pay.
  • Round each line to cents and add the lines. Pricing the total once hides the line that is wrong.
  • Leave parking, tolls and other travel costs out of the mileage total and attach them separately.

The sample uses the 2026 IRS business rate. If the employer pays a different rate, replace the Rate column and recalculate. The calculator prices a month at the rate in force. The Excel workbook does the line arithmetic.

From trip records to an approved claim

A form is the last step, not the first. The records behind it decide whether the claim gets paid.

  1. Record each trip as it happens. Record the date, route, purpose and distance for each trip. The log is the evidence behind every row on the form. A claim rebuilt from memory at month end gives a reviewer nothing to check. Mileage log templates.
  2. Remove commuting and personal miles. Travel between home and your regular workplace is commuting, not business mileage. Keep it out of the claim, or keep it in its own category so the split is visible. Commuting vs business mileage.
  3. Price the business miles at the rate in force. Use the rate for the trip date. A claim that crosses a rate change needs both figures, one on each row. Do not type one rate over the whole claim. Price a month in the calculator.
  4. Attach the log and the receipts outside the rate. The mileage rate covers the cost of operating the car. Claim parking, tolls and other travel costs separately, with their receipts. Do not fold them into the distance. US mileage recordkeeping.
  5. Get the approval and submit it with the pay period. The form includes the certification and the signatures. The policy sets who approves, when the claim is due, and what happens to an excess payment. Mileage reimbursement policy template.

The IRS asks for the trip record as well as the total: date, destination, business purpose and miles. The form includes those fields. The mileage log has the detail behind them.

What to attach, what stays separate

The mileage rate covers the cost of operating the car. It does not cover every cost of the trip. Payroll can reduce or return a claim that adds those costs to the rate.

Attach or reference

  • The mileage log or trip report behind the rows.
  • The employer's policy, or the official rate publication for the date.
  • Parking, toll and ferry receipts, with the amount in the Notes column or on a separate expense line if the employer uses one.
  • The approval reference or email, if the signature block is not enough for your process.
  • A note for any policy exception, such as a higher rate or a passenger.

Keep outside the mileage total

  • Parking fees and tolls. The IRS allows business parking and tolls in addition to the standard mileage rate.
  • Ferries, congestion charges and other journey costs that are not part of operating the car.
  • Hotel, meals and airfare on a trip that also used a car are travel expenses, not mileage.
  • Fuel and maintenance receipts when the employer pays actual expenses instead of a rate. Do not claim the rate and the actual cost for the same trip.

What the form does not do

  • The form does not decide whether a trip is business. The employee and the approver do.
  • The form does not replace the mileage log or the receipts.
  • The PDF is a print layout, not a fillable form. Use Excel or Word to type.
  • The form is not an official tax form. It does not calculate tax or file a return.
  • The form is for a personal vehicle used for business. The employer's fleet process usually handles a company car with a fuel card.

The IRS allows business parking and tolls in addition to the standard mileage rate. Keep the receipts and put the amount on a separate expense line or in the Notes column. Do not add it to the Rate or Distance column. IRS Publication 463 has the parking and tolls paragraph, and the recordkeeping checklist covers the records behind the claim.

Mistakes that send a claim back

Most returned claims are not arithmetic errors. They have missing evidence or a rate that does not match the trip date.

The purpose says only "work".

Name the client, site or project and the reason: "Client meeting, Cedar Park" tells a reviewer more than "work".

The claim applies one rate to the whole year.

Put the rate on each row. A 2026 US claim that crosses July 1 has trips at 72.5 cents and trips at 76 cents.

The claim has no start or destination.

A trip with only a start or only a destination is incomplete. Write both ends, even when the return leg is the same road.

The claim adds miles to kilometres.

Set the distance unit once on the claim. If the unit changes mid-year, start a new sheet.

The claim includes commuting miles.

Home to the regular workplace is not business mileage. Remove it, or keep it in its own category outside the claim total.

The approval has no name or date.

An approval line without a person and a date is not an approval. Add both before the claim goes to payroll.

The rate includes parking.

Claim parking and tolls separately, with the receipts. Adding them to the rate hides the cost and can double-count it.

If you claim outside the United States

You can use the form's columns in any country. The rate and the record rules do not. Use the country's own rate and log requirements.

United Kingdom

HMRC

HMRC's approved mileage rates set the tax-free amount. The record has to show the dates and mileage of the journeys. You can use the form's fields. HMRC sets the rate and the relief rules.

Canada

CRA

The CRA's automobile allowance rates are tiered by kilometres. If you claim actual vehicle expenses, keep the year's total kilometres so you can work out the business-use share.

Australia

ATO

The ATO's cents-per-kilometre method has a cap. The logbook method needs a continuous 12-week logbook. The form submits the claim. The logbook supports it.

The blank Excel formats Rate and Amount as plain numbers, so the sheet takes the currency the policy pays. The sample uses US dollars and the 2026 IRS rates.

Frequently asked questions

Is there an official IRS mileage reimbursement form?

No. The IRS publishes the standard mileage rates and the record rules in Publication 463, but it does not issue a claim form for an employee to submit to an employer. Employers use their own form. The blank form includes the per-trip fields Publication 463 asks a mileage record to show: date, destination, business purpose and miles. Form 2106 is a different document. It is for the narrow group of employees who can still deduct job expenses, not for a normal employer reimbursement.

What should a mileage reimbursement form include?

The claim header needs the employee name and ID, department, company, claim period, submission date, distance unit and rate basis. Add one row per trip with the date, purpose, start, destination, distance, rate and amount. Add an approval with a dated signature, a note for parking or tolls claimed separately, and a certification that the miles were business miles.

What is the difference between a mileage log and a reimbursement form?

A log records the trips. A form submits them for payment. The log is the evidence behind each row, and the form is the request with the total, the certification and the approval. Keep them together so every line on the form traces back to a record.

Should I use Excel, Word or PDF?

All three files carry the same nine trip columns, so the choice is about how you fill the claim in. Excel calculates the Amount column and the total, Word lets you replace the header or the policy wording, and the PDF is the one you print and sign by hand. It is not a fillable form, so type into Excel or Word if you need to edit on screen. Each of the three is shown in full before you download one.

How is the reimbursement amount calculated?

Multiply the business miles or kilometres on the row by the rate that applies to that trip, then add the line amounts. For a 2026 US claim, the IRS benchmark is 72.5 cents per mile from January 1 to June 30 and 76 cents from July 1. The form uses the rate your employer's policy sets. The IRS figure is a benchmark, not a rule that sets a private employer's rate.

Can I include commuting miles?

No. Travel between home and your regular workplace is commuting, not business mileage, and the IRS treats it as a personal expense. Keep commuting out of the claim. If you record it for a business-use calculation, put it in its own category so a reviewer can see the split.

What if the rate changed during the year?

Put the rate in force on the trip date in that row. In the US, 2026 has two business rates, so a claim that covers trips before and after July 1 needs both. Pricing the whole claim at one rate overstates or understates the total. The filled sample shows 5 trips across that change.

Are parking and tolls included in the mileage rate?

No. The standard mileage rate covers the cost of operating the car. Business parking and tolls are claimed in addition. Keep the receipts and put the amount in the Notes column or on a separate expense line. Do not fold it into the distance or the rate.

Do I need receipts for every trip?

The trip record is the evidence for the mileage: date, destination, business purpose and miles. Keep receipts for parking, tolls and any actual expenses claimed separately. An accountable plan also asks you to account to your employer within a reasonable time. Submit the form with the log instead of reconstructing it months later.

How long should I keep the form and the log?

For a US tax deduction, keep the records for three years from the date you file the return. For an employer reimbursement, the employer's retention policy controls. Keep the form and log with the payroll records for at least that long. When more than one rule applies, keep the longer period.

Is mileage reimbursement taxable?

A reimbursement under an accountable plan is not wages. The employer pays a business expense, the employee provides evidence, and the employee returns any excess. A flat allowance without evidence is generally taxable. The form is part of the evidence, not a tax return. The taxability guide covers the difference.

Can I use this form in Canada, the UK or Australia?

You can use the form's columns, but the rate and the record rules are country-specific. Use the country's own rate and log requirements: HMRC's approved mileage rates and records, the CRA's automobile allowance records, or the ATO's logbook or cents-per-kilometre method. The form does not replace those records.

Can I use this form if I am self-employed or drive for a gig app?

The form is a claim to an employer. An employee asks the employer to pay business miles. A self-employed driver claims the mileage deduction on Schedule C from a mileage log, not a reimbursement form. The same trip records support it. A gig driver who is treated as an employee uses the employer's process. An independent contractor claims the deduction instead.

Can I use this form for a car allowance?

No. A car allowance is a fixed payment, usually monthly, that does not depend on the miles driven. This form claims business miles. If the employer pays both an allowance and mileage, the policy decides how the two work together, and the allowance's tax treatment is a separate question. The car allowance guide covers that choice.

Where this comes from

The documents below state the record an employer and a tax authority ask a claim to show. Some of this guidance is our advice rather than an authority's words, such as putting the rate on every row or keeping one unit on the form. An employer's policy can ask for more.