F02110 Certification or Reimbursement of Benefit Travel

F02110 Certification or Reimbursement of Benefit Travel

Instructions:

1.   Complete Section 1.  It is mandatory to select a Type of Travel.

2.   Complete section 2 below, which applies to the type of travel you are certifying or requesting reimbursement for.

3.   In all cases, please attach evidence of benefit travel when submitting this form:

4.   For more information, refer to Staff Rule 6.13 for Home Leave and Staff Rule 6.15 for Emergency Travel.     

Document required
Alternate Document
Signed Form 2110
No alternate document

 E-ticket receipt

 (Along with itinerary, ticket cost, and proof of payment)

 Alternate for ticket receipt (a & b or C)

a. Itinerary routing and ticket cost sent by the travel agency
b. Credit card or bank statement showing the relevant transaction/Payment details included in the e-ticket itinerary/ traveagent invoice containing mode of payment for verifying the proof of  payment)

c .  Mileage statement summary

Boarding Passes

a. Exit pass from Duty station
b. Entry pass into the home country
c. Exit pass from the home country
d. Entry pass into Duty station

Alternate for boarding pass (a&b or c or d)

a. Passport pages entry/exit stamps
b. First page of the passport
c. Mileage statement summary
d. Credit card statement showing the expense incurred in the home country for a minimum of five days       

                                                                                   Requirements for Surface travel (if undertaken):

Dated gasoline/toll/food receipts etc. en-route to and return from the home country, and hotel/credit card statements showing transactions effected in the home country/other receipts during your stay in your home country for minimum of five days.
Passport pages including the first page, showing entry and exit stamps for each eligible traveler whenever possible. If your HCT country does not stamp passports, you must document your length of stay through other documents such as hotel receipts, credit card purchases in your home country, etc.



Note: If any of the above documents are missing and the alternate documents could not be submitted, please contact HR Operations. For emergency travel: in addition to air or surface travel documentation (see above), include death certificate or notice, or similar evidence. For air travel paid from personal funds, include proof of purchase (e.g., credit card receipt). For tickets paid using Frequent Flyer miles, only the taxes and fees incurred are reimbursable, hence include receipt of taxes and fees incurred. The total cannot exceed the economy fare.

 

 5.   Submit form and supporting documentation to CTRQC, MSN MC5-506 in a 10x13 manila envelope.

NOTE: Country Office Staff MUST submit form to Country Office Manager for approval.

 6.   Retain copies of all documents submitted. Originals cannot be returned.

 5.   Submit form (reimbursement claim) and supporting documentation to HR Operations at MSN G2-202.

NOTE: Country Office Staff MUST submit form to Country Office Manager for approval.

 6.   Retain copies of all documents submitted. Originals cannot be returned.

5.   Submit form and supporting documentation to CTRQC, MSN MC5-506 in a 10x13 manila envelope.

NOTE: Country Office Staff MUST submit form to Country Office Manager for approval.

6.   Retain copies of all documents submitted. Originals cannot be returned.

5.   Submit form (reimbursement claim) and supporting documentation to HR Operations at MSN G2-202.

NOTE: Country Office Staff MUST submit form to Country Office Manager for approval.

6.   Retain copies of all documents submitted. Originals cannot be returned.

Instructions:

Welcome to the World Bank Group HR Forms Instructions page.

This form filler tool is designed to assist you in electronically entering your data and printing a paper form with a unique barcode corresponding to your entered data. Once you've completed your answers and printed the form, you'll need to submit it either by email or in person, depending on the form type.  Please note that the data you enter is directly captured in the form's unique barcode, so it's important that you do not make any handwritten changes, corrections, or additions to the data or to the form after it has been printed. Doing so may result in data errors and processing delays.

In case you notice any errors after printing your form, or if you've left a field blank, we recommend starting over and completing a new form. It's also important to remember that your information is not saved by the form filler and can no longer be accessed after you print it. Therefore, please be extra careful in reviewing your answers, as it is impossible to make any corrections after the form is printed

Each form will take approximately ten minutes to complete. Please ensure you have the needed documents such as passport to extract information that may be required in some fields. Do not close the forms until they are ready for a download. Partially filled forms cannot be saved to be completed later. If you need further assistance, please contact. Thank you!

 

Information on Completing the Form:

1.   It is mandatory to select a Type of Travel.

2.   Provide details of the type of travel you are certifying or requesting reimbursement for.

3.   In all cases, please attach evidence of benefit travel when submitting this form.

4.   For more information, refer to Staff Rule 6.13 for Home Leave and Staff Rule 6.15 for Emergency Travel.

Document required

Alternate Document

Signed Form 2110 

No alternate document

E-ticket receipt

(Along with itinerary, ticket cost,

and proof of payment)

Alternate for ticket receipt (a & b or c)

a. Itinerary routing and ticket cost sent by the travel agency

b. Credit card or bank statement showing the relevant transaction/Payment details included in the e-ticket itinerary/ travel agent invoice containing mode of payment for verifying the proof of payment.

c. Mileage statement summary

Boarding Passes
a. Exit pass from Duty station
b. Entry pass into the home country
c. Exit pass from the home country
d. Entry pass into Duty station

Alternate for boarding pass (a&b or c or d)
a. Passport pages entry/exit stamps
b. First page of the passport
c. Mileage statement summary
d. Credit card statement showing the expense incurred in the home country for a minimum of five days    

                                  Requirements for Surface travel (if undertaken)

Dated gasoline/toll/food receipts etc. en-route to and return from the home country, and hotel/credit card statements showing transactions effected in the home country/other receipts during your stay in your home country for minimum of five days. Passport pages including the first page, showing entry and exit stamps for each eligible traveler whenever possible. If your HCT country does not stamp passports, you must  document your length of stay through other documents such as hotel receipts, credit card purchases in your home country, etc.

 

Note: If any of the above documents are missing and the alternate documents could not be submitted, please contact HR Operations.

For emergency travel: In addition to air or surface travel documentation (see above), include death certificate or notice, or similar evidence. For air travel paid from personal funds, include proof of purchase (e.g., credit card receipt). For tickets paid using Frequent Flyer miles, only the taxes and fees incurred are reimbursable, hence include receipt of taxes and fees incurred. The total cannot exceed the economy fare. 

For Home Country Travel

a.  Send electronic copies of supporting documents to homeleavecertification@worldbank.org.

b.  Retain originals of all documents

For Emergency Travel arranged by the World Bank

a. Scan and attach the completed form and supporting documentation directly via Travel Web

     NOTE: Country Office Staff MUST submit form to Country Office Manager for approval.

b. Retain original copies of all documents for one year from the trip end date, as per policy.

For Emergency Travel paid with Personal Funds and/or Emergency Travel using Frequent Flyer Ticket

a.  Submit form (reimbursement claim) and supporting documentation to HR Operations

     by email to  HROperations@worldbank.org or by FAX to 202-522-7026

     NOTE: Country Office Staff MUST submit form to Country Office Manager for approval.

b.  Retain copies of all documents submitted. Originals cannot be returned.

Revision 25 Apr 2023

Staff Member Details

All staff members must complete this section

Staff member's name*

World Bank Group UPI*

Authorized destination*

Actual destination*

Type of travel*

Section 2:  Fields will be displayed after selecting Type of Travel in Section 1.

Home Country Travel - List eligible travelers including self.  Send electronic copies of supporting documents to  homeleavecertification@worldbank.org.

Name(Last, First)*

Relationship*

Departure Date From Duty Station*

Arrival Date in Home Country*

Departure Date From Home Country*

Arrival Date in Duty Station*

My eligibility date for this home country was*

Travel was by*

Travel option*

If other, specify*

My spouse/domestic partner is a World Bank Group employee*

Was Home Country Travel combined with Operational Travel*

If yes, Operational travel request number*

Emergency Travel

I hereby confirm Emergency Travel took place and was paid with Frequent Flyer Ticket

I hereby confirm Emergency Travel took place and was paid by the World Bank Group

I hereby confirm Emergency Travel took place and was paid with Personal Funds

Paid By*

Scan and attach the completed form and supporting documentation directly viaTravel Web

Emergency benefit travel request number*

Submit form (reimbursement claim) and supporting documentation to HR Operations by email to HR Operations@worldbank.org or by fax to 202-522-7026

NOTE: For emergency travel using a Frequent Flyer ticket, reimbursement is limited to taxes/fees for one eligible traveler only.

Taxes/Fees paid*

Travel Details

Airfare amount/currency

Class of travel

Distance of round-trip surface travel

Miles

Kilometers(Km)

Start date of travel*

End date of travel*

Official duty station*

Actual departure location (if different from duty station)

NOTE: For emergency travel, only one family member is eligible for this benefit, even if it's a Bank/Bank couple.

Name of deceased

Date of death

Relationship of deceased to staff member

Name of traveler

Relationship of traveler to staff member

Name of deceased

Date of death

Name of traveler

Relationship

If other, specify

Certification and Signature

I certify that all monies and tickets provided by the World Bank Group have been used in accordance with the Staff Rules.  I understand that:

1.   Further travel will not be authorized if the documentation provided is not acceptable to the World Bank Group.

2.   Failure to submit appropriate documentation will result in repayment of full benefits to the World Bank Group.

3.   The use of these benefits is subject to audit by the World Bank Group or its representatives and I authorize release to the World Bank Group of any relevant information from any source such as airline records, etc.

4.   Any misstatement regarding use, abuse or misuse of the benefit may result in disciplinary action under  SR 8.01, Disciplinary Measures.

 

Remarks

Staff Member's Signature
Date

CONTROLLERS USE ONLY

COUNTRY OFFICE USE ONLY

After filling this document, you must sign and date it before returning this document to the World Bank Group. Please ensure ALL information in the submission form is complete and accurate before printing the form. This will generate your form(s) as a PDF file. Review the file for accuracy and completeness. If there is an error, please start a new form.