EXPENSE REIMBURSEMENT DECLARATION

To:
FONDAZIONE
PISTOLETTOCITTADELLARTE ONLUS
Via Serralunga, 27
13900 Biella (BI)

Name and surname Arie Amaya

Date and place of birth Zipaquira, Colombia, 28.06.1984
Address 1. Sokak 22/2
City Buca, Izmir
Country Turkey
Nationality Colombian
CF (for Italian only)
Passport n. AU200363
Mobile n° 393454427599
email ari.akkermans@gmail.com

By signing this document, I hereby declare that I am participating in the UNIDEE residency
programs "UNIDEE residency Modules: Neither on land nor at sea" at CITTADELLARTE –
FONDAZIONE PISTOLETTO ONLUS - Biella from 8-16 April 2024 supported by illycaffè S.p.A.

For the above reason, I request to be reimbursed for the travel expenses incurred by me the total
amount of: € 100 by bank transfer to my personal account.
Attached please find the originals of the proofs of payment for purchasing them.

Bank account details

Bank name Ziraat Bankası
Address Kasimpasa Branch
Account 628-101926250-5003
IBAN TR950001009010192625005003

Bic/Swift TCZBTR2AXXX

place and date: Bari, 04.04.24

signature: