Claim ROTARY INTERNATIONAL  DISTRICT 9570  Inc Claim
Office of the Treasurer
C/- Chris Carroll
PO Box 670
Gladstone Qld 4680
Expenses Claim 
Claimant's Name            
Given names Surname
of the  Rotary Club of        
Claimant's Address              
St/Rd/Box No City/Town State Postcode
Claimant's Banking Details            
(for direct deposits) BSB Code Account No Account Name  Bank 
Claim Details  Claim Type Date/s   Details     $
Travel    
   
Accommodation    
   
Kilometrage   km @  
  km @  
Reimbursement     
   
Other (Specify)    
   
Total   
Claimant's Declaration
   
                   
I…………………………………………………………. declare that  I have incurred the above expense(s) in pursuance of an Approved
and Budgeted Rotary District 9570 Programme or Event  
           
Claimant's Signature                  
PLEASE ENSURE THAT ALL DOCUMENTS SUPPORTING THIS CLAIM ARE ATTACHED 
AND FORWARDED TO THE OFFICE OF THE TREASURER FOR PROCESSING
District Use                   
             
Claim checked by     Date      
             
Claim approved by     DG/DGE/DGN Date      
         
Programme Budget      Date Paid       
or Account Code