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
    Private zoneHoja de Validación
    Reembolso de Gastos