Review and checkout

Name:	Terry Doe
Customer Care number:	00000001
Claim number:	12345678

Name:

John Doe

Customer care number:

00000001

Claim number:

12345678

Your expense details

Please review the information you’ve entered and if it is correct, click Submit below.

Advil

Service or purchased on Aug 13, 2022

123 Groceries

1 unit at $24.24 per unit

Edit Remove

Subtotal:	$24.24
PST:	$1.70
GST/HST:	$1.21
Total:	$27.15

Bandages

Service or purchased on Aug 13, 2022

123 Groceries

1 unit at $12.99 per unit

Edit Remove

Subtotal:	$12.99
PST:	$0.91
GST/HST:	$0.65
Total:	$14.55

Total for this reimbursement request: $41.70

Email notification

In the past, you indicated you would like us to send emails confirming we’ve received your reimbursement request and letting you know when we’ve processed your request to the email address below. Please remove or update the email address before continuing if needed.

terrydoe@email.com

Change email

I certify that I incurred these expenses. I understand that it is considered fraud or misrepresentation to claim the same expenses from more than one source. I authorize the release of any information or record requested in respect of this claim to WorkSafeBC or its agents and certify that the information given is true, correct, and complete to the best of my knowledge.

Back Submit