Validation / Expense Reimbursement Sheet


    VALID EXPENSES FOR THE HOSPITAL OR VALIDATOR CENTER

    Own vehicle

    YesNo

    Total Km

    Transport

    YesNo

    Per diem

    YesNo

    Lodgement

    YesNo

    Others

    YesNo

    Fixed expenses per visit

    YesNo

    Accompanying expenses

    YesNo

    HOSPITAL OR CENTER VALIDADOR


    Amount of Tickets and Amount

    *Required fields

     
    If you want you can this form and send it already filled to the address:
    Apartado de correos F.D. n 1 - 4111001
    41110 - Bollullos de la Mitación (Seville)

    or by Email to the email: dcarbajo@distefar.com