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Vendor Extension Form - page 1 of 1

FORMER PMI EMPLOYEE FORM - claim of reimbursable expenses

Section 1. GENERAL DATA

Former
Employee's
Name

Section 2. BANK DETAILS

Bank Name

Street

City Country

Bank Key/Sort Code Swift Code

Bank Account No.

IBAN (Mandatory for EURO Payments Intra-EU/EEA)

Post Giro / PBC-ESR No.

Bank Account Holder Name

Comment: Please transfer the total amount in the defined currency to the Employees's bank account.

Section 3. EXPENSE DETAILS

Receipt amount Equivalent to be


Expense type Business reason Expense Date paid (amount and
and currency currency)

Airfare

Hotel

Taxi

Meals

Parking

Other

Total amount:

Currency:

Cost Center WBS

Section 4. Employee's signature

Name Signature Date

Section 5. Employee's Line Manager's or HR Approval

Approved by:

Name Signature Date

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