Moving Expense Reimbursement Request and Authorization Form

New UB employees should use this form to request reimbursement for approved expenses when transporting themselves, their families, and household goods and personal effects to their new place of residence.

Read the Moving Expense Reimbursement policy.

Download the Form

Request and Agreement for Moving Expense Reimbursement (AC1099-S) (.pdf)
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Completing the PDF Form

  1. Read through all pages of the document to find specific instructions, if any
  2. Enter requested information into the form
  3. Print the form
  4. Get required signatures
  5. Scan a copy of the signed form for your records
  6. Send the original, completed, signed form to:         

** Must be completed and signed by appointing officer and appointee and submitted to appropriate office for reimbursement.

Form Facts

Form Type: Web link

Requirements: Adobe Reader

Updated: 12/2018

Owner:  Office of the State Comptroller