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)
