Demande de remboursement des frais de transports
(en voiture privée)
Claim for reimbursement of travel expenses
(by private car)

Date:      

Demande adressée à / Claim addressed to:  Hélène Cambron

Objet de la demande / Object of the claim: Claim for reimbursement of travel expenses for the Linguistic seminar LI/2016/05 “Language training on the vocabulary of Competition Law”

Description de la demande / Description of the claim:

Address of departure:      

       km x 0,22€ / km =       €

Travel by private car: cost of 0,22 EUR per kilometre for a round trip up to a maximum of 1.200 km calculated on the basis of the shortest route (itinerary mapping in support – Michelin/Google Internet Maps), using the following formula: Kilometre claim       km x 2 (in-out) x 0,22 € / km =      
    
Participants who choose to use their own car remain fully liable for any accidents to their car or to third parties.
  
Nom et adresse / Name and address: 
     

     

     

Amount :       €

Date and signature: