DECLARATION FORM
amber
NAME : ADDRESS
PLACE: COUNTRY:
ACCOUNT NR.: BANK NAME:
BANK ADDRESS: PLACE/COUNTRY
IBAN: BIC-CODE
SWIFT code: ABA routing nr (US only)
In case of currencies different than Euro:
Name of Currency: Country:
Conversion rate: Date of conversion rate:
DATE DESTINATION / SPECIFICATION OF COSTS PROJECT FOREIGN CURRENCY
NUMBER CURRENCY AMOUNT TOTAL COSTS ( in € )
SUBTOTAL € 0.00
'-/- ADVANCED AMOUNT
PLEASE ADD ORIGINAL RECEIPTS TO RECEIVE / TO PAY: € 0.00
REMARKS: DATE: DATE:
SIGNATURE DECLARANT: SIGNATURE BUDGET HOLDER: