travel-reimbursement-request-translation

Antrag auf Reisekostenvergütung
Bitte beifügen:
RKA 10 / 2013
Original der Dienstreisegenehmigung bzw. bei Nichtbediensteten Reiseauftrag, Flugscheine, Belege, Rechnungen und Lieferscheine über Fahrkosten,
Nebenkosten, ggf. Übernachtungskosten, sowie Zahlungsnachweise, ggf. bei Zuschussbewilligung Kopie der Zusage
not employed by JGU
Family name, first name, title / position
personell no. (if available):
83564783
Mouse, Mickey, Dr.
employed by JGU
Institute, working group
Telefon / Telefax:
private address (street, house-no., zip-code, city)
E-Mail:
06131 39 23652
Inst. f. Physik, Komet 8
[email protected]
Mäusestr. 26, 36824 Entenhausen
IBAN (international Bank account number, 22 digits):
name of your Bank:
BIC (bank code, 11 digits):
Dagobank Scrooge McDuck
DE12500105170648489890
PBNKDEFF
allowance received from third party
advance payment received
maximum amount to be reimbursed
€
/r
flight was booked through Carlson Wagonlit Travel (CWT) using direct charge to the AirPlus-credit card.
flight
train ticket
accomodation was direktly payed by ???
I am aware, that I have to use frequent flyer miles acquired on business travels for other business travels.
Mainz, 07.05.2014,
I declare that the information given in this form is correct.
(City)
2014
Year:
Course of the journey
month
Day
times
Mai
01.
09:00 starting date
Mainz
Duckburgh
Mai
Mai
Mai
Mai
use additional sheet if
driven
with you (names) /
necessary
km
outward journey:
attach receipts
km
Euro
conference
fee: 120,00
44,67 DD
at destination:
city bus: 2x 3,50
hotel : 180,00 (69
Duck Dollars)
ending time of the journey
Was the travel connected to
persons travelling
attach receipts /
travel documents
train: 85,00
15:00 arrival (date)
16:00 starting time of the business
19.00 ending time of the business
20.25 return journey
from (city of departure): Duckburgh
to (destination):
Mainz
means of transport: Bahn
distance
weight of baggage
Euro
means of transport (e.g. Flug (flight), Bahn (train), Auto (car):
additional charges
if you took a car
reservations
from (city of departure - has to be Mainz):
01.
01.
04.
04.
(signature)
travel expenses,
(if you visited several business
destinations, use extra sheet)
to (destination):
M.Mouse
(Date)
return journey:
explanations (e.g. why you used a taxi or car rental):
a private stay:
X
no
yes
from
till
per diem
I renounce any per diem
I renounce the per diem except the breakfast included in the accomodatin)
free meals received at the hotel or conference. please tick the respective days:
X X3 X4
breakfast
1
2
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
lunch
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
dinner
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Accomodation / accomodation allowance (abroad)
I renounce accomodation allowance
free accomodation (e.g. included in the conference fees)
reimbursement with receipt
accomodation costs, breakfast included
accomodation costs, half/full board included
The booking of the accomodation was done through
CWT
yes
no
yes
no
- if yes, please add list of meals
myself *
host
other*
*In this case add explanation why accomodation costs were necessary.
Just for business travel abroad
borders crossed:
place
Mousetown
place
Did you have lunch in a canteen?
Disneyland
country
date
exchange rate
(add proof)
01.05.2014
(for flights: landing time)
time
date
time
no
yes, from
till
-
chtbedienstete / r
dienstete / r
llig):
s Antragstellers)
sten
zblatt benutzen
Zahlungse beifügen
Euro
:
29
30
29
30
31
29
30
31
ert auflisten -
s*
unkt der Landung)
tt benutzen)
31

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