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ESTRO AISBL
Rue Martin V, 40 - 1200 Brussels – Belgium
www.estro.org-
education@estro.orgTel: +32 2 775 93 40
REIMBURSEMENT FORM
Please send the signed form with your
original
receipts to the ESTRO project manager responsible of the course
within 30 days from the end of you travel.
DETAILS
Name:
Course:
Date and place:
EXPENSES
Description
Currency
Exchange
rate**
Amount in
EUR
Per diem
Onsite travel costs
(
country of the course)
Local travel costs
(
in faculty’s country)
Other expenses*
Total claim
*The per diem covers every cost
except
for the taxi, public transport, toll, miles with private car and
parking incurred for the course. Any other expense must have been agreed with the project manager
before. Please note that all reimbursements will be done in Euro. By claiming these costs from ESTRO the
undersigned declares not to claim for the same expenses elsewhere.
**Please use the rate of
www.oanda.com(day of the expense = rate to be used)
o
Wire the total claim in the last bank account provided.
o
Wire the total claim in another bank account (please fill in the annex bank details)
Date
Signature