Make check payable to:                                                                                                                                                                     Expense Type: (Check One)
            Send to:                                                                                                                                                                                 NAIC Regulator/Comm                                                                                       NAIC Business**
                                                                                                                                                                                             Nat'l Mtg Designated Staff*                                                                             State Zone/Grant Funds
                                                                                                                                                                                                      Funded Consumer Rep                                                                            Zone Business Expense
                                                                                                                                                                                                                       Speaker                                                                      Zone Technical Training
                                                                                                                                                                                    *Only used for 1 sr staff per Member. Must be designated by       **Only used for non-NAIC employee and non-Insurance Dept  employee  travel                                   
                                                                                                                                                                                                           Commissioner.                                                                                
                                                                                                                                          2022 NAIC EXPENSE REPORT
                                                                                                                                                                       US Dollars
                                           Traveler:
                                                                                                                                    Day 1                     Day 2                   Day 3                   Day 4                  Day 5                   Day 6                   Day 7
                                                           Date
            Travel Destination(s)
            Purpose of Trip(1)
            Personal                                       Mileage
            Auto                                           Miles X $0.585                                                                      0.00                    0.00                    0.00                   0.00                    0.00                    0.00                    0.00 
                                                           Parking
            Ground                                         Car Rental
            Transportation                                 Taxi/Subway/Rail
            Airfare                                        Airfare
                                                           Airfare Booking Fee
                                                           Tips/Baggage
            Change Fees                                    Airfare Change Fee
            Hotel                                          Room Charge
                                                           Tips/Baggage
            Meals                                          Breakfast
                                                           Lunch
                                                           Dinner
                                                           Business Meals(2)
            Registrations                                  Registration Fee
            Miscellaneous                                  Telephone
                                                                                 (2)
                                                           Other Expenses  
                                                   DailyTotals
            I certify that these travel expenses were incurred by me in the transaction of authorized NAIC business.
                                                                                                                                                                                                                                                                  Total Expenses
                                                                                                                                                                     ACCOUNT DISTRIBUTION
                                                  Traveler Signature/Date                                                       Description                Acct/Dept                Amount                           Project Code                                 Less Advances
                                                                                                                         Personal Auto
                                                                                                                         Ground Trans                                                                                                                  Less Chrgs pd by NAIC 
                                            State Department Approval/Date                                               Airfare                                                                                                                                    (from page 2)
                                                                                                                         Change Fee
                                                                                                                         Hotel                                                                                                                                        Amount Due 
                       NAIC COO/CEO, Director, NIPR CEO, IIPRC Exec. Dir./Date                                           Meals
                                                                                                                         Registration
                                                                                                                         Miscellaneous                                                                                                                                        ACCOUNTING USE ONLY
            NAIC CFO    Date               Controller's Office   Date                                                                                                                                                                                                         Vendor #
            (1)                                                                                                                                                                                                                      Acctg Review/Date
                Provide the purpose of the business trip or meal, including the dates of the business function/meeting.
            (2)
                Detail in "Business Meals/Other" section on page 2.                                                                                                                                                                                                           Voucher #
                                                                                                                                               Page 1 of 4
       G:\FINANCE\DATA\ACCTG\FORMS\Expense Reports\2016\2016 NAIC Ins Summit Expense Report.xlsx
                                                                                 Page 2 of 4
                                                                                         NAIC Business**
                                                                              State Zone/Grant Funds
                                                                             Zone Business Expense
                                                                             Zone Technical Training
                                              **Only used for non-NAIC employee and non-Insurance Dept  employee  travel                                   
                                                                          
2022 NAIC EXPENSE REPORT
 US Dollars
                                                                            TOTAL        CATEGORY
                                                                                         SUBTOTAL
                                                                             Y
                                                                          
                                                           ACCOUNTING USE ONLY
                                                                                 Page 3 of 4
                                  EXPENSES BILLED/CHARGED DIRECTLY TO NAIC                                                       BUSINESS MEALS AND OTHER EXPENSES (3)
                    P                                Business Expenses                                                Date              Names, affiliation & business purpose           Amount
                   A          Date                   Description                    Amount
                   I
                   D
                   D
                   I
                   R
                   E
                   C
                   T
                   L
                   Y
                   B
                   Y
                                                                     Subtotal
                   T
                   H                Personal Expenses (Do not show on page 1 of this report)
                   E          Date                   Description                    Amount
                   
                   N                                                                                                             Total Business Meals and Other Expenses
                   A
                                                                                                                 (3)
                   I                                                                                               For all business meals, please include (1) the names of all 
                   C                                                                                             individuals present and their affiliation, (2) the business
                                                                     Subtotal                                    purpose of the business meal and (3) the exact amount and
                                                       Total Charged to NAIC                                     date of the expense.
         Comments:
         Should the NAIC seek reimbursement for these expenses?  Yes or No (Circle One) 
            If yes, please attach a completed Billing Request Form. To obtain this form, send an email request to acctgrec@naic.org.
         Mail forms to: NAIC Finance Department, 1100 Walnut Street, Suite 1500, Kansas City, MO 64106
                                                                                                                                                                                         Revised 12-21
                                                                                               Page 4 of 4