Travel Cost Reimbursement

un number:
(one copy each for the participant and organizer)
Dear HELCOM Youth Forum 2012 participant,
HELCOM Youth Forum 2012
10 – 12 December 2012, Rostock
Travel Cost Reimbursement
The reimbursement of your travel costs is carried out by the HELCOM Youth Forum 2012 lead partner – the
Baltic Sea Forum e.V., Hamburg.
Contact details:
Mr. Dr. Markus Köhl & Mr. Jürgen Schmidt
Baltic Sea Forum e.V.
Große Bahnstraße 31, 22525 Hamburg, Germany
Email info@baltic-sea-forum.org
Please fill in this form to get your reimbursement of your travel costs to a maximum of 450,00 EUR.
Note: No reimbursement without tickets, receipts, boarding cards etc.
1. Personal data and bank account information
Name, Surname
Address
City
Country
Email
Tel.
Bank account holder
International Bank Account
Number (IBAN)
Bank
1

2. List of tickets, Itinerary
Ticket EUR Direct reimbursement at venue
Direct reimbursement at venue -
TOTAL
3. Signatures, Date
Prepayment amount of
,- EUR received
_____________________________________________________
4. University relation - University-level education
_____________________________________________________
_____________________________________________________
_____________________________________________________
Participant
Baltic Sea Forum e.V.
2