LoA and Reimbursement – go-study-europe

LoA-reimbursement

LETTER OF ACCEPTANCE AND INFORMATION FOR REIMBURSEMENT

PERSONAL INFORMATION

First Name:

Last Name:

Email:

Phone number:

Date of birth:

Other:

Your Organisation:

Other:

I participate in

From:

Until:

Address

Street name:

House number:

City:

Postal code/ ZIP:

Country:

BANK ACCOUNT INFORMATION:

Account holder’s name:

Name of the bank:

IBAN:

BIC/SWIFT:

Additional information:

DECLARATION OF CONSENT

Declaration of Consent for Data Processing

By completing the current form, I hereby consent to my data from this form being collected, stored and used for reimbursing my costs / receiving grant for covering my accommodation and/or travel costs during my participation in the selected activity.
I can revoke this consent at any time without stating any reasons; furthermore, I can request information on the stored data and demand correction, deletion and restriction of my personal data. To do so please contact europim@fh-dortmund.de

Declaration of Consent to participate in the activity

I hereby consent that the Fachhochschule Dortmund and the EuroPIM Office (as the Organising committee of the activity) dispose of the funds related to my accommodation and/or travelling expenses and that they may spend them accordingly to the project allowances.
I acknowledge that in the case of not participating in the activity without proper justification I am obliged to return all money payed for me, as well as to cover all extra costs that may be caused by this. All money must be returned and payed within the next six weeks after the activity concluded.

I can revoke this consent at any time without stating any reasons; furthermore, I can request information on the stored data and demand correction, deletion and restriction of my personal data. To do so please contact europim@fh-dortmund.de

LETTER OF ACCEPTANCE AND INFORMATION FOR REIMBURSEMENT

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