Fees and Expenses Claims Form - NCCR MSE · For EU-/EFTA residents: Stopover in Switzerland for...

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Honorarabrechnung_Form_2015_01_ENG.pdf Fees and Expenses Claims Form Title, Surname, First Name: Address: Country, Post Code, City: Telephone: Date of Birth: Nationality: e-mail: Mr. Mrs. Payee: Institut / Seminar: This section should be completed only by individuals resident in Switzerland. Socialsecurity-Nr. Work Permit: C-Permit B-Permit L-Permit Self-employed in Switzerland: Yes (Please enclose official confirmation of the Federal Mutual Compensation Fund) Service claimed: Dates worked from: to: Marital Status: Divorced Widowed Married Separated Single Reg. partnership Amount payable to: BIC IBAN Nr. Name of account holder must be the same as above. Country, Post Code, City Name of Bank/Post Office The services were provided overseas. I confirm, that i am a self-employed person in my homecountry (USA, Canada, Philippines). Surname / First Name: Swiss residents: Unless otherwise stated, no AHV/IV/EO- and ALV-deductions are made for amounts below CHF 2'300.00. For EU-/EFTA residents: Stopover in Switzerland for more than 8 days a Form E101 is obligatory! Fees / petty remuneration Expenses (see attached receipts) Total 49020 48010 Date Designation Amount in Account Cost Centre / Order ..................................................................................................................... Date, Signature of Claimant: Date, Certified by Institute/Seminar: ..................................................................................................................... Status: Student Scholar (Please enclose the official permition)

Transcript of Fees and Expenses Claims Form - NCCR MSE · For EU-/EFTA residents: Stopover in Switzerland for...

Page 1: Fees and Expenses Claims Form - NCCR MSE · For EU-/EFTA residents: Stopover in Switzerland for more than 8 days a Form E101 is obligatory! Fees / petty remuneration. Expenses (see

Honorarabrechnung_Form_2015_01_ENG.pdf

Fees and Expenses Claims Form

Title, Surname, First Name:

Address:

Country, Post Code, City:

Telephone:

Date of Birth:

Nationality:

e-mail:

Mr. Mrs.

Payee:

Institut / Seminar:

This section should be completed only by individuals resident in Switzerland.

Socialsecurity-Nr.

Work Permit: C-PermitB-Permit L-PermitSelf-employed in Switzerland: Yes (Please enclose official confirmation of the Federal Mutual Compensation Fund)

Service claimed:

Dates worked from: to:

Marital Status:Divorced Widowed

MarriedSeparated

Single Reg. partnership

Amount payable to:

BIC

IBAN Nr.

Name of account holder must be the same as above.

Country, Post Code, City

Name of Bank/Post Office

The services were provided overseas. I confirm, that i am a self-employed person in my homecountry (USA, Canada, Philippines).

Surname / First Name:

Swiss residents: Unless otherwise stated, no AHV/IV/EO- and ALV-deductions are made for amounts below CHF 2'300.00.

For EU-/EFTA residents: Stopover in Switzerland for more than 8 days a Form E101 is obligatory!

Fees / petty remuneration

Expenses (see attached receipts)

Total

49020

48010

Date Designation Amount in Account Cost Centre / Order

.....................................................................................................................Date, Signature of Claimant:

Date, Certified by Institute/Seminar: .....................................................................................................................

Status:StudentScholar

(Please enclose the official permition)

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