NCU Student’s name and family name: …………………………………………………………………

Address:………………………………………………………………………………………………………………..

Student ID number:……………………………

DECLARATION OF PLANNED ECO-JOURNEY

I declare that I am planning to make a journey related to Erasmus+ mobility to

…………………………………………………………………………………………………………………………………………………………………………
(name of the host university, city, country)
in the following manner:

1. journey to the host university

 means of transport ………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………….
 route (date and place of departure – date and place of destination)
…………………………………………………………………………………………………………………………………………………….
2. journey from the host university
 means of transport ………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………………………………….
 route (date and place of departure – date and place of destination)
…………………………………………………………………………………………………………………………………………………….

I undertake to deliver to DIPEM/DRP CM the “Declaration of completed eco-journey” along with copies of
tickets/ticket bills confirming my journey within 6 weeks from completing my mobility.

I acknowledge that failure to submit the “Declaration of completed eco-journey” within the required period
will cause the obligation to return the whole amount of Erasmus+ grant received in relation to the eco-
journey.

……………………………………………..
……………………………………………….
place, date and student’s/doctoral student’s legible signature