UNITED NATIONS NATIONS UNIES VOUCHER FOR REIMBURSEMENT OF EXPENSES Examiner: Approving Officer: Currency: Country: Voucher No.: Date: To be completed by Controller Amount: Cheque No. Bank No. TO BE COMPLETED BY CLAIMANT (Please TYPE or PRINT) PAYEE: Cheque to be: Called for at CASHIER’s Office - Indicate your Tel. Ext. Mailed to following address: Mailed to following BANK A/C: AND Payee Advice to be mailed to: At-tac h-ment No. DESCRIPTION OF EXPENSES Tickets purchased, Terminal Expenses, Telegrams, Taxis, Authorized excess baggage’s, etc. Signed PT-8 Airline ticket (copy) Boarding cards or final statement of departure Terminal expenses eg depart The Hague Terminal expenses eg arrive Sarajevo Terminal expenses eg depart Sarajevo Terminal expenses eg arrive The Hague Witness Expenses as per attached Other Expenses 1. Enter your name, index number and phone number here CATEGORY: 2. Put your bank account details here. ICTY will send any payments due to your bank account Duty Station: This space to be filled in by HQ. Dept., Div. or Office: PT.8 or MOD No.: 3. Please indicate where your processed copy can be sent to you? Account No.: DATE LOCAL CURRENCY EXCHANGE RATE U.S.$ EQUIVALENT For Financial Services Approved Amount 1 2 3 4 5 6 7 4.Which terminal 5. State how much at each terminal, up to $USD27 own transport, or $USD9 with UN paid for transport. SOP-TRA-001 6. Using policy on witness expenses, state amount and attach worksheet policy SOP-TRA-004 TOTAL TRAVEL ALLOWANCE (See REVERSE SIDE) TOTAL 7. List all other expenses that are claimed, eg telephone AI/2000/11 fuel and vehicle AI/2000/12 I claim the subsistence and terminal expenses in connection with the journey (as indicated on the reverse 14. Sign and date side hereof), which I certify to have local trspt IC/99/29 been made as authorized. I further certify that all expenses claimed the claim represent actual disbursements made by me, and dependants indicated, actually travelled as shown. Signature of Claimant: _________________________________________ Date: ______________________ LESS ADVANCES BALANCE DUE UN IF ANY .................... NET PAYMENT This claim is in conformity with the journey as actually authorized. Payment of subsistence and/or transit allowances, is approved for all official stopovers and necessary travel time reported by the Claimant on the reverse side, except as otherwise noted by me. NO EXCEPTIONS Signature of Admin./ Certifying Officer: ____________________________________________ Date: ______________________ GENERAL ACCOUNT AMOUNT (U.S.$) Dr. or Cr.* ALLOTMENT ACCOUNT LIQUIDATION AMOUNT FINAL CLAIM FOR EXCEPTIONS, SEE REVERSE OBLIGATION DOCUMENT DESCRIPTION/ I.O.V. Total Debits * Indicate by brackets Total Credits Total Liquidations Submit Claim - ORIGINAL plus ONE copy to FINANCIAL SERVICES - ONE copy to CERTIFYING OFFICER F.10 (ICTY 1-98)- E. TO BE COMPLETED BY CLAIMANT PLEASE TYPE or PRINT: Extra sheets should be attached with full explanation of lengthy or involved travel. Submit a separate Form F.10 if eligible dependants have itineraries which differ from yours. Subsistence may be subject to a reduction after 60 days under Staff Rules. Do you have eligible dependants residing with you at your official duty station? Yes No DATE CITY AND COUNTRY OF DEPARTURE OR ARRIVAL MODE OF TRAVEL D A Y M O N T H Y HOUR* E A R Indicate whether UN or GOVT. vehicle was made available at DEP. and/or ARR. ANNUAL LEAVE TO BE CHARGED: 00 DAYS Remarks: List names and ages of dependants 8.How many private days For Use of Controller ONLY COMMENTS OF ADM./CERTIFYING OFFICER REGARDING STOP-OVER DELAYS, ETC. Yes No x x 13. Was a UN, or hire car or govt vehicle available to take you to the terminal (depart) or from the terminal (on arrival). DEP.: THE HAGUE ARR.: SARAJEVO Air KL85 Air Official Personal 27 04 00 27 04 00 4pm 6pm X 30 08 00 30 08 00 9am 11am x x DEP.: SARAJEVO ARR.: THE HAGUE Air KL86 Air Official Personal X DEP.: ARR.: Official Personal DEP.: 9. Itinerary to be stated, each leg, ARR.: including internal trips by car DEP.: ARR.: Official Personal DEP.: ARR.: Official Personal DEP.: ARR.: Official Personal DEP.: ARR.: Official Personal * HOUR should indicate time of departure from or arrival at airports, piers or railroad stations. Any deviation from itinerary and standards of accommodation authorized by Form PT.8 and any stop-over not authorized thereby must be supported by full explanation; otherwise your claim may be reduced. 10.State whether the UN or Airline provided you with free meals or accommodation Official Personal 12.Time and dates of travel. These should be reflective of where the night was spent. 11. Mode of travel (eg Air, Surface, Ferry ), including flight, bus or train numbers if applicable, or UN, military, or hire car etc Important Information NOTICE TO TRAVELLER: All receipts for transportation and excess baggage coupons (MCO’s) must be returned to the United Nations together with the original Travel Authorization (PT.8) and attached to the claim. The Laissez-Passer should be returned to Visa and Entitlements Unit upon completion of the travel. REMARKS: (List here attached unused tickets by stating ticket number and the route covered by the ticket.) Total Travel Allowance in U.S.$ . . . . . . . . . . Value of MCO’s received: Value of MCO’s used: U.S.$ U.S.$ BALANCE of MCO’s to be returned to the U.N.: U.S.$ The balance of the MCO’s is represented by the following coupon numbers: F.10 (ICTY 1-98)- E.