Author: Elmer Boon Bofur Studio en Lenie Zandvliet
Last saved by: Mathias Kirsten
Company: Bedrijf

CLAIM FOR TRAVELLING AND SUBSISTENCE EXPENSES MLNET II

Name :	
Organisation :
Date(s) of expenses :
Destination:						claim in euro’s or GB (Only for UK claims !!)
Purpose of expense :

TRANSPORT
Ticket
From:			To:		 Amount (ticketcurrency):	             	Amount (EURO):

Private car 
From:			To:		 Total km’s			@ 0.18 EURO 

(N.B. LOCAL TRANSPORTATION IS COVERED BY DAILY ALLOWANCE)

DAILY ALLOWANCE
From (date)		To (date)	Total days			@ 110  EURO

OTHER EXPENSES NOT COVERED BY “TRANSPORT” and “DAILY ALLOWANCE” (please specify)

SIGNIFICANT SPECIFIC TASK COST (PRIOR APPROVAL REQUIRED!)
(e.g. registration fee, cost participation non-members)

Total  :							        □	EURO 
							        □	GB
							        (please tick)

I certify that the expenditure has been necessary, not extravagant and wholly incurred for the purposes specified.
I enclose a report on the event (if required, i.e. workshop, conference, seminar, tutorial or visit):  □ (please tick)

I require payment by cheque / by bank transfer (delete as applicable)

Signature of claimant :					Date: 

Payee details:  (i.a.:  if applicable)
Name:						Address:
Tel.						Fax:			email payee:
Name of bank:					Address of bank:				
Accountnumber: 					SWIFT code bank (i.a)
Payment reference (i.a.)				Sort code bank (i.a.)