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EWM travel grant reimbursement form
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Personal details
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First name
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Last name
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E-mail address
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Personal Street Address
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Postal code and city
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Travel grant
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Amount of travel grant
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Date notified
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Conference or workshop title
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Dates of conference/travel
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Bank account details (information marked with * are needed in the bank is not in a SEPA country and not in IBAN format)
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Account holder
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Bank account number
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SWIFT/BIC code
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Name of the bank*
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Bank address*
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Postal code and city*
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Country*
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The bank account does
not receive payments in euros (yes/no)*
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Total amount in EUR
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Receipt dateShort description
Amount in EUR
Original currency
Amount in original currency
(if not in EUR)		Conversion rate used
(if not in EUR)
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