Docstoc

HCF Reimbursement Claim (Hospital Excess Payment)

Document Sample
HCF Reimbursement Claim (Hospital Excess Payment) Powered By Docstoc
					                                   Human Resources


                                   HCF Reimbursement Claim (Hospital Excess Payment)                                                                                                             T11
 REIMBURSEMENT CLAIMS
 To avoid any delay in payment please ensure that the original receipt issued by the hospital for the payment of the excess together with a copy of your HCF Memebership Card is attached to this form.
 Please forward to Human Resources, H14, Attention: Pam Tindill.

 1. EMLOYEE INFORMATION
 Employee No                                Surname                                     Given Names                                       Date of Birth (ddmm                      Mail No


 2. REIMBURSEMENT CLAIMS
                                                                   Reimbursement Details                                                                                                        For HR
 General Ledger Account Code (15 digits)                                                                                                                                  Amount
                                                                   (Attach Receipts / Tax Invoices)                                                                                          purposes only

 1   3   1    8   7   0    8   4    5   7    8   8    4   0   0                                                                                                                              REIMB
 1   3   1    8   7   0    8   4    5   7    8   8    4   0   0
 1   3   1    8   7   0    8   4    5   7    8   8    4   0   0
 1   3   1    8   7   0    8   4    5   7    8   8    4   0   0
 1   3   1    8   7   0    8   4    5   7    8   8    4   0   0
                                                                                                                                                           Total Claim



 3. AUTHORISATION
 Claimants Name:
 Extension:

 Signature:

 Date:




Privacy: Swinburne University of Technology collects, uses and destroys your employee information in accordance with the University Employee Records policy. All
privacy queries should be made to: riwilliams@swin.edu.au                                                                                        December 2009

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:17
posted:4/25/2010
language:English
pages:1
Description: HCF Reimbursement Claim (Hospital Excess Payment)