Appendix V For Campus Services Section Use Only Case Number -- F Reimbursement Ref. Received On Building Flat Type Staff Record for Furniture Reimbursement Staff No. Faculty / Dept. Previous claims: Items Staff Name A. Flat type E-mail (Please √ ) Tel./ Ext. Quantity MOP □ T1 MOP35,000 □ T2 MOP47,000 □ T3 MOP60,000 To be input by ACC Reference Amount 1. Year:_______ PVR-201_-__-______ 2. Year:_______ PVR-201_-__-______ 3. Year:_______ PVR-201_-__-______ 4. Year:_______ PVR-201_-__-______ 5. Year:_______ PVR-201_-__-______ B. Sub-total Current claims: Items Quantity MOP 1. PVR-201_-__-______ 2. PVR-201_-__-______ 3. PVR-201_-__-______ C. Sub-total Balancing claims (A-B-C) Document Checklist for Staff Quarter Furniture Reimbursement Staff Quarter Furniture Reimbursement Request Form signed by Claimant/Applicant Staff Record for Furniture Reimbursement signed by Claimant/Applicant Original Receipts/Invoices 3 Standard Quotation Forms and/or 3 Quotations provided by local vendors are required when the purchase value of furniture items is in the amount of MOP15,000 or above (according to DL NO. 122/84/M)  本人聲明所提供與本申請表有關的資料正確無誤，並聲稱報銷金額是真實的開支金額。本人明白若聲明者對事實作出虛假之聲明是違反澳門刑法典的罪行。 I declare/endorse that the information provided in relation to this application form is true and correct and amounts claimed are a true statement of the expenses incurred. I further understand that if a declarant deliberately makes a false declaration is an offence to the Criminal Law of Macau. Claimant’s/Applicant’s Signature & Date: ________________________________ / / (DD) / (MM) / (YYYY) To be Completed by Campus Services Section Remarks: Handled and Verifed By: CS Housing Team 澳門大學格式五 UM - Modelo 5 Date: (DD) / (MM) / (YYYY) Approved and Endorsed By: Head of Campus Services Section Guidelines on Staff Quarter Furniture Purchase (For New Campus Only) Appendix V - Page 1 of 1 Date: (DD) / (MM) / (YYYY) Ref: csdf/48/2013