CSNSW SPORT REIMBURSEMENT & ALLOWANCE CLAIM FORM Claim request for allowance or the reimbursement of expenses incurred acting on behalf of CSNSW Sport – NSWCPS MacKillop, NSWCPS Polding or NSWCCC NAME* - required EMAIL* - required MOBILE* - required SPORT* - required EVENT NAME* - required EVENT START DATE* - required EVENT FINISH DATE* - required EVENT PLEASE SELECT MACKILLOP SELECTIONS POLDING SELECTIONS CCC SELECTIONS NSWPSSA EVENT ALL SCHOOLS EVENT SCHOOL SPORT AUSTRALIA NSWCPS EVENT NSWCCC EVENT MEETINGS OTHER ROLE PLEASE SELECT NSWCPS TEAM OFFICIAL NSWCCC TEAM OFFICIAL CONVENOR EVENT OFFICIAL OTHER Item Description & Amount (Please Only Claim if Applicable): Sustenance Allowance (Breakfast Maximum $20 per day) Breakfast x0 Breakfast x1 Breakfast x2 Breakfast x3 Breakfast x4 Breakfast x5 Total Breakfast Amount Claiming Sustenance Allowance (Dinner Maximum. $35 per day) Dinner x0 Dinner x1 Dinner x2 Dinner x3 Dinner x4 Dinner x5 Total Dinner Amount Claiming Kms (Please only claim up to the max as stated on your letter of appointment) Other Items (If applicable and approved by the CSNSW Sport office before purchase): UPLOAD RECEIPTS (All non allowance claims must have receipt/s attached to them) UPLOAD RECEIPTS (All non allowance claims must have receipt/s attached to them) UPLOAD RECEIPTS (All non allowance claims must have receipt/s attached to them) UPLOAD RECEIPTS (All non allowance claims must have receipt/s attached to them) UPLOAD RECEIPTS (All non allowance claims must have receipt/s attached to them) TOTAL CLAIM AMOUNT* - required CLAIM DETAILS - EFT DETAILS ACCOUNT NAME* - required BSB* - required ACCOUNT NUMBER* - required REFERENCE* - required I Confirm the Above Account Details are correct* - required OFFICE USE ONLY COST CENTRE & PROGRAM ACCOUNT TOTAL AMOUNT APPROVED BY DATE SIGNATURE Mandatory field(s) marked with *