EuChemS reimbursement claim

Personal data

Name and surname of claimant*

Email of claimant*

Date of claim*

Expense description*

(e.g. event/meeting attended)

In case of Division expenses

Treasurer's email

Chair's email

If yes, then please provide the name of the Secretary of the PN, as this will be the person authorising this reimbursement form

Secretary's email

Expenses

Please list all items and related requested information.

Please upload your receipt(s)/invoice(s) here*

Please note that you shall provide invoice/receipt for ALL expenses claimed.

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 100 MB, Max. files: 20.

Total amount claimed in euro*

Total amount claimed in other currency(s). Please indicate the currency(s)*

Disclaimer

Please, note that the following converter will be applied for currencies other than EUR: https://www.oanda.com/currency-converter/en/?from=EUR&to=USD&amount=1

Bank details

Please fill in the bank details

Bank name*

Bank address*

Street, postcode, city, country

BIC/SWIFT Code*

Claimant's details

Name and surname of the claimant*

Address of the claimant*

Street, postcode, city, country

Account number*

Sortcode (if applicable)

IBAN No*

Signature

Max. file size: 100 MB.

Confirmation and Submission

By typing your name in the box bellow, you declare that all of the information provided in this form is true and accurate and that, in case of being required to provide further proof of payment/invoices you will send them to .*

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EuChemS reimbursement claim

EuChemS Expense Claim Form