NNPS Reimbursement form

NNPS

Nordic Neuropediatric Society

Nordic Neuropediatric Society

- a collaboration between the neuropediatric societies in the Nordic countries

NNPS Reimbursement form

NNPS Reimbursement Form


Please send the completed form with receipts to: Charlotte Reinhardt Pedersen, NNPS treasurer, Sötoften 8, Ramlöse Sand, DK -3300 Fredriksvaerk, Denmark, crp@dadlnet.dk, +45 22447226




Name………………………………………………………………………………………………………………………




Address……………………………………………………………………………………………………………………



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Bank details

Name of bank………………………………………………………………………………………………………………………



Address……………………………………………………………………………………………………………………



………………………………………………………………………………………………………………………………


Account number……………………………………………………………………………………………………………………



IBAN………………………………………………………………………………………………………………………



SWIFT……………………………………………………………………………………………………………………



Purpose…………………………………………………………………………………………………………………



Receipt Nr          Item                                                               Amount (currency)          Amount (Danish kroner)


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1


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2


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3


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4


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Total amount (Danish kronor).......................................................................


Date                                                          Signature







NNPS treasurer authorized                          Date                                Signature







NNPS

Nordic Neuropediatric Society