Please provide accurate employee and vehicle information to ensure proper cost center allocation and fleet management tracking. All fields marked with business-critical data are mandatory for processing.
Employee Full Legal Name
Employee Corporate ID Number
Primary Department or Business Unit
Cost Center Code for Reimbursement Allocation
Direct Manager Name
Corporate Fleet Vehicle ID Number
Vehicle VIN (Last 8 Characters)
Vehicle Make and Model
Vehicle Assignment Start Date
Do you have a company-approved home wallbox charger installed?
Home Wallbox Charger Manufacturer and Model
You must use only public fast-charging networks for corporate vehicle charging. Please proceed to Section 4 for public charging location verification requirements.
Home Charger Serial Number
Home Charger Installation Date
Certified Installer Company Name
Upload Home Charger Installation Certificate and Electrical Safety Compliance Document
Is the home charger connected to a dedicated utility sub-meter?
Sub-Meter Serial or Identification Number
Which public fast-charging networks are you authorized to use? (Select all applicable)
Electrify America
EVgo
ChargePoint Public
Ionity
Tesla Supercharger
Shell Recharge
BP Pulse
Other Network
Additional Vehicle or Charger Notes
This section captures precise energy consumption data from vehicle telematics and/or utility sub-meter readings. Accurate kWh data is essential for reimbursement calculations and carbon footprint tracking.
Billing Cycle Start Date
Billing Cycle End Date
Total kWh Consumed (Vehicle Telematics Aggregate)
Do you have utility sub-meter data to corroborate telematics?
Sub-Meter kWh Reading (Start of Cycle)
Without sub-meter data, reimbursement will be calculated using 100% telematics data and standard corporate rates. Ensure vehicle telematics are accurately reporting all charging sessions.
Sub-Meter kWh Reading (End of Cycle)
Upload Sub-Meter Photograph with Clear Reading Visible
Individual Charging Session Telematics Log
Session Start Timestamp | Session End Timestamp | kWh Delivered | Charging Location ID | Charger Type | Starting State of Charge % | Ending State of Charge % | ||
|---|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | G | ||
1 | 6/15/2025, 10:30 PM | 6/16/2025, 6:15 AM | 45.2 | HOME-WALLBOX-01 | Level 2 AC | 15 | 100 | |
2 | 6/18/2025, 12:45 PM | 6/18/2025, 1:20 PM | 28.7 | EA-STATION-4521 | DC Fast | 45 | 85 | |
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Were there any charging sessions from non-corporate vehicles on this sub-meter?
Estimated kWh Consumed by Non-Corporate Vehicles
Explain any discrepancies between telematics and sub-meter readings (>5% variance)
Upload Telematics Data Export (CSV or PDF from Fleet Management System)
Calculate reimbursement using corporate-approved rates or actual utility tariffs. Itemization ensures transparency and compliance with expense policies.
Reimbursement Rate Calculation Method
Corporate Flat Rate per kWh
Actual Utility Tariff Rate
Time-of-Use Corporate Rate
Mixed Rate (Home/Public Charging)
Corporate Flat Rate per kWh
Actual Utility Tariff Breakdown
Tariff Component | Rate per kWh | kWh at This Rate | Sub-Total | ||
|---|---|---|---|---|---|
A | B | C | D | ||
1 | Base Energy Charge | $0.12 | 300 | $36.00 | |
2 | Delivery Charge | $0.08 | 300 | $24.00 | |
3 | Demand Charge (if applicable) | $0.05 | 300 | $15.00 | |
4 | $0.00 | ||||
5 | $0.00 | ||||
6 | $0.00 | ||||
7 | $0.00 | ||||
8 | $0.00 | ||||
9 | $0.00 | ||||
10 | $0.00 |
Time-of-Use Rate Schedule
Time Period | Hours | Rate per kWh | kWh Consumed | Calculated Cost | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | Off-Peak | 22:00 - 06:00 | $0.18 | 280 | $50.40 | |
2 | Mid-Peak | 06:00 - 16:00 | $0.25 | 120 | $30.00 | |
3 | On-Peak | 16:00 - 22:00 | $0.35 | 87.5 | $30.63 | |
4 | $0.00 | |||||
5 | $0.00 | |||||
6 | $0.00 | |||||
7 | $0.00 | |||||
8 | $0.00 | |||||
9 | $0.00 | |||||
10 | $0.00 |
Mixed Charging Rate Calculation
Charging Type | kWh | Rate per kWh | Total Cost | ||
|---|---|---|---|---|---|
A | B | C | D | ||
1 | Home Charging (Corporate Rate) | 400 | $0.28 | $112.00 | |
2 | Public Fast Charging | 87.5 | $0.45 | $39.38 | |
3 | $0.00 | ||||
4 | $0.00 | ||||
5 | $0.00 | ||||
6 | $0.00 | ||||
7 | $0.00 | ||||
8 | $0.00 | ||||
9 | $0.00 | ||||
10 | $0.00 |
Total Calculated Reimbursement Amount
Does this expense include any charging session costs that were directly billed to a corporate account?
Amount to Deduct (Already Paid by Corporate)
Final Reimbursement Request Amount (After Deductions)
Upload Supporting Documentation (Utility Bills, Public Charging Receipts, Rate Schedules)
I certify that the reimbursement calculation is accurate and complies with corporate sustainability expense policies
Verify charging location context and grid connectivity to ensure proper carbon accounting and expense categorization. Off-grid charging may involve renewable energy sources requiring separate validation.
Primary Charging Location Type for This Billing Cycle
Primary Residence On-Grid
Primary Residence Off-Grid with Renewable
Public Charging Network
Workplace Charging Facility
Secondary Residence
Other Location
Is your home charging location equipped with solar panels or other renewable generation?
Estimated Percentage of EV Charging from Renewable Sources
Can you provide GPS location data for all charging sessions?
Upload GPS Data Export from Vehicle or Charging App
Explain why GPS verification is not available and provide alternative location proof
Time-of-Use Verification by Charging Session
Session Start | Grid Status | TOU Rate Period | Verified by Telematics? | Verified by Sub-Meter? | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | 6/15/2025, 10:30 PM | On-Grid | Off-Peak | Yes | Yes | |
2 | 6/18/2025, 12:45 PM | On-Grid | On-Peak | Yes | ||
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Did any charging occur during declared grid emergency or peak demand events?
List dates and explain business necessity for charging during restricted periods
Confidence Level in Location and Time Data Accuracy
Very Low Confidence
Low Confidence
Moderate Confidence
High Confidence
Complete Confidence
Upload Any Additional Location Verification (Photos, Charging Network App Screenshots, etc.)
Final authorization requires dual approval from Fleet Management and Expense Operations to ensure policy compliance, budget allocation accuracy, and audit readiness.
Fleet Manager Name
Fleet Manager Employee ID
Fleet Manager Verification: I have reviewed vehicle telematics data and confirm charging sessions align with business use policy
Fleet Manager Verification: Vehicle mileage and charging patterns are consistent with assigned role requirements
Fleet Manager Risk Assessment Score (1=Low Risk, 5=High Risk for Audit)
Fleet Manager Digital Signature and Approval
Fleet Manager Approval Timestamp
Expense Operations Lead Name
Expense Operations Lead Employee ID
Expense Operations Verification: Reimbursement calculation has been validated against supporting documentation
Expense Operations Verification: Amount falls within authorized budget and cost center limits
Expense Operations Verification: All required supporting documents are attached and properly categorized
Expense Operations Audit Notes and Exceptions (if any)
Expense Operations Lead Digital Signature and Final Approval
Expense Operations Approval Timestamp
Final Submission: I certify that all information provided is accurate, complete, and subject to corporate audit and verification procedures
To configure an element, select it on the form.