EQAR Reimbursement Form

Personal Information

Name :

I am filling this in as :

E-mail : *

Account Information

Note: If we already have your bank account information, it is not necessary to provide us with this information again. In case there is any change in your account information, kindly update it here.

Account Holder :

IBAN :

SWIFT/BIC :

Meeting(s) : *

Date(s) : *

Important points while filling in the form:

1. Fill in the details of each receipt/invoice separately.

2. Kindly use decimal point " . " instead of a decimal comma" , " as a decimal separator while entering the total cost.

3. Kindly attach all the bills/invoices for which the reimbursement claim is made.

Type of reimbursement : *

Meeting(s) and expenditure description : *

Currency : *

Euro	Other Other

Rate of exchange : *

Total cost (in EUR) : *

Please choose : *

Repeat (I have more costs to declare)

Done ( I have filled in all the costs)

Type of reimbursement : *

Meeting and expenditure description: *

Currency: *

Euro	Other Other

Rate of exchange : *

Total cost (in EUR) *

Please choose: *

Repeat (I have more costs to declare)

Done ( I have filled in all the costs)

Type of reimbursement : *

Meeting and expenditure description: *

Currency: *

Euro	Other Other

Rate of exchange : *

Total cost (in EUR) *

Please choose: *

Repeat (I have more costs to declare)

Done ( I have filled in all the costs)

Type of reimbursement : *

Meeting and expenditure description: *

Currency: *

Euro	Other Other

Rate of exchange : *

Total cost (in EUR) *

Please choose: *

Repeat (I have more costs to declare)

Done ( I have filled in all the costs)

Type of reimbursement : *

Meeting and expenditure description: *

Currency: *

Euro	Other Other

Rate of exchange : *

Total cost (in EUR) *

Please choose: *

Repeat (I have more costs to declare)

Done ( I have filled in all the costs)

Type of reimbursement : *

Meeting and expenditure description: *

Currency: *

Euro	Other Other

Rate of exchange : *

Total cost (in EUR) *

Please choose: *

Repeat (I have more costs to declare)

Done ( I have filled in all the costs)

Type of reimbursement : *

Meeting and expenditure description: *

Currency: *

Euro	Other Other

Rate of exchange : *

Total cost (in EUR) *

Please choose: *

Repeat (I have more costs to declare)

Done ( I have filled in all the costs)

Type of reimbursement : *

Meeting and expenditure description: *

Currency: *

Euro	Other Other

Rate of exchange : *

Total cost (in EUR) *

Please choose: *

Repeat (I have more costs to declare)

Done ( I have filled in all the costs)

Type of reimbursement : *

Meeting and expenditure description : *

Currency: *

Euro	Other Other

Rate of exchange : *

Total cost (in EUR) *

Please choose: *

Repeat (I have more costs to declare)

Done ( I have filled in all the costs)

Type of reimbursement : *

Meeting and expenditure description: *

Currency: *

Euro	Other Other

Rate of exchange : *

Total cost (in EUR) *

Sum total costs (EUR) :

0.00

Supporting documents (Receipts, Invoices) *

I hereby declare truthfully that these expenses were incurred in connection with the meeting mentioned and have not been claimed from any third party *

Please check this box to confirm the above