IOBC/WPRS Refunding Declaration Form
IOBC/WPRS Refunding Declaration Form
IOBC/WPRS Refunding Declaration Form
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<strong>IOBC</strong>/<strong>WPRS</strong> <strong>Refunding</strong> <strong>Declaration</strong> <strong>Form</strong><br />
Postal Address:<br />
Dr. Sylvia Blümel<br />
Persönlich<br />
<strong>IOBC</strong>-<strong>WPRS</strong> Treasurer<br />
Austrian Agency for Health and Food Safety (AGES)<br />
Institute of Plant Health (PGH)<br />
Spargelfeldstr. 191<br />
A-1220 Wien<br />
AUSTRIA<br />
Please send this form correctly and<br />
completely filled out to the<br />
treasurer. Please fill in all details<br />
requested and enclose all proofs.<br />
Only correctly filled forms can be<br />
processed. For requests please<br />
contact: sbluemel@ages.at<br />
Title: Family name: First name:<br />
Function in <strong>IOBC</strong>/<strong>WPRS</strong>:<br />
Total amount owned by <strong>IOBC</strong>/<strong>WPRS</strong> (in EUR)<br />
Received from the treasurer (cash) amount<br />
To be paid<br />
amount in EUR<br />
(deduct any partial payments already received from the above amount)<br />
On account No.<br />
Bank (Post)<br />
Bankcode (Swift-code)<br />
IBAN<br />
Place of Bank<br />
Country<br />
I certify the correctness<br />
Date<br />
Signature
Justifications<br />
Travelling expenses<br />
Air-fare<br />
EUR<br />
Train Ticket<br />
EUR<br />
Private car Km EUR<br />
Other (Taxi)<br />
EUR<br />
Accommodation<br />
Other expenses (please specify)<br />
Total<br />
EUR<br />
Grand Total (to reported on the front side)<br />
EUR<br />
Please note that <strong>IOBC</strong>/<strong>WPRS</strong> will pay car expenses only exceptionally and usually only<br />
remunerate the equivalent to train fares.<br />
Air-fare must be economy, train, if not previously agreed, second class.<br />
Proofs are included for all positions except:
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