ISA Expense Claim (Judges and Officials)

Ice Skating Australia Incorporated

Affiliated to the International Skating Union
Expense Claim Form (Judges and Officials)
This Application Form Contains 3 Sections:

Section 1 - Applicant Details and Bank Details

Section 2 - Claim Section
- (PART A) Itemised Details and Reason for Expenditure
- (PART B) Financial Assistance from other Organisations
Section 3 - Applicant Acknowledgement

Please Ensure all relevant sections are completed.

Note: Claims could take betwen 6 - 8 weeks to be processed and paid. If you choose to use an overseas bank account processing time may vary and transaction and exchange charges may apply.

Section 1 - Applicant Details
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
State Association*
Please provide your BSB and Account number of the account that you prefer payment from ISA to be made to.
Name on Account*

First NameLast Name
Bank*
Branch*
BSB*
Account Number*

Part B - Financial Assistance from other Organisations

I wish to advise and declare that I have also applied for and have been granted additional financial assistance in relation to this claim.
Item 1
Item 2
Item 3
Item 4
Total Amount (B)*

Section 3 - Applicant Acknowledgement
Please Note: amount reimbursed will be up to the amount of financial assistance entitled
Total Expenditure Claim (A) - (B)
Amount of Financial Assistance Entitled to Claim*
I certify that I have incurred the above expenditure on behalf of Ice Skating Australia Inc and that the total amount claimed is due and payable to me.
Applicant Agreement*

Agree
Signature of Applicant*
Date*

MonthDayYear
Should be Empty:

Ice Skating Australia Incorporated