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