Student, Visitor and Conjoint Reimbursement Form

Overseas bank account

Name
Address
Suburb		State
Country		Postcode
Phone Number		Email Address
University Staff Contact		Phone Number

Faculty/Division
School/Unit

Claim Type	Student	Student Number
	Conjoint	Staff Number
	Visitor	Creditor Code

Bank Account Holder's Name		Bank Name
Branch Name
Branch Address	(PO Box is not acceptable)
Suburb		State
Country		Postcode
Branch Swift code
Bank account number/IBAN	(IBAN Mandatory for European countries only)
Routing number or branch code	(Mandatory Routing for Canada/USA, Branch code for NZ/South Africa)

The rates per kilometre are per the current ATO rates.

Foreign currency receipts should be converted to Australian Dollars. Foreign currency exchange rates.


Claimant Declaration I certify that the above claim is for University business purposes only and is true and correct in every detail.
Claimant Name	Signature	X
Date
Approver Declaration I certify that the above claim has been checked for accuracy and is approved expenditure for University business purposes.
Approver Name	Signature	X
Position/Title
Date

Please make sure you have completed all the relevant fields before printing

The University of Newcastle, Australia