Bruker-

.
Statens fellesblankett Travel and subsistence claim form nummer
Surname and National identity
Karl Smith Byrne PT5752906 R/N
forename no (11 digits)
Postal code City Vedleggsnr.
Home
address 60 The Heyes OX1 2BU Oxford

Post Doc Fellow Name/Code of bank Bank acct.

Position (write on reverse side) Girobank GB77BUKB20651863040909

Agency/ Dept./ Tj.steds-

Institution IARC Divisjon Genetics nummer
Employee no. Tax Municipal- Tax Date Time
Departure
(4 or 5 digits) municipality ity code per cent 22/10/2019

Claim in Destination and purpose of journey Date Time

connection with Course Official journey Return 24/10/2019
Please specify Overn. (See reverse side) Board
Oslo, IDLung Meeting stay
Other Hotel house Other
Amounts SD- TT- Rate Amount Virksomhetsregnskap
claimed Code Code M Number NOK øre NOK øre Kontering Kode 2 Kode 3 Kode 4
Total expenses
from reverse side 1041 9148
Incident.
expenses 619 1057
Under 5
hours 1041
5-9 hours
Subsist- 614 1083
ence
allow- 9-12
hours 614 1084
ance, no
overnight More than
stay 12 hours 614 1085
6-12
hours 614 1042
More than
12 hours 614 1042
8-12
Subsist- hours 610 1086
ence
More than
allowan-
12 hours
610 1087
ce, with
over- 610 1052
night Foreign
stay
Foreign 610 1052
Over- GTAS*
night (domestic) 610 1053
accom-
modation Overnight hotel
supple- accom. domestic 610
ment
No GTAS*
vouchers (foreign) 610
Private car: 1)
0-9,000 km
Use of own Private car: 2)
transport- more than 9.000 km
ation.
Home - work
Please (taxable portion) 111 1069
specify
journey on Private car:
reverse Passenger suppl. 714 1045
side Other

Stay Subsistence
exeeding allowance
28
28 days
days Overnight
accommodation
allowance
Other Other
expences

Sub-total
Deduc- Breakfast/
tions lunch/dinner 614 1 ÷
Breakfast/
lunch/dinner 610 1 ÷
GRAND TOTAL
Less Paid by 8020 Travel no.
advance (Specification on
received reverse side) ÷
NET -
TOTAL Claimed Due to inst.
Claimant’s Date I, the undersigned, agree that any amount due may be deducted from my salary. Approval
signature (sign. of
authorizing
Paid by
Payment (institution) Utbetales og posteres i samsvar med foranstående
Date Payment authorization Countersignature

Receipt for Sum received Date Signature Utbetalingsstedets merkn. ved utbetalingen
payment made
in cash
X-0095 E (Godkj. 08-2005) Elektronisk utgave * GTAS = Government Travel Allowance For regnskapsføreren: 1) Kode SD 712/TT 1047 2) Kode SD 152 / TT 1054
scale for domestic and foreign travel
Name National identity
Journey specification Expenses
FROM To Mode of transport* Currency
Date Total km Exhange rate Amount
Time Country and Place Country and Place Time Type Code Amount
priv. transp.

22/10/2019. 07.05. London, Heathrow. Oslo, Norway 10:05 Plane £ 151.01 11.74. 1,784.21

24/10/2019. 21:30. Oslo, Norway London, Heathrow. 23:30 Plane £ 151.01 11.74. 1,784.21

Authoriza- Date Total km this jorney. Carry forward to Use Sub-total

tion for use of own transportation on front page. 3,568.42
of private
car Authorizing officer Mark with X
+ Total mileage this year (km) if transferring km.

Cumulative mileage this year(km)

*When travelling by air, state country of destination.
*For use of private car, please include:
Itinerary - distance driven for each journey, listed by destination and speedometer reading
-reason for detours - local mileage at destination.

Calculating subsistence
Expenses for accommodation, food, etc.
allowance Currency Exhange
Travel period in connection Date Specification
Code Amount rate
with a course ends when the
course starts. New travel period 22/11/29. Hotel Accommodation two nights NOK 5580
is initiated at the time course
concludes.

If subsistence allowance is to
be calculated on the basis of
days exceeding 6 hours, the
number of days should be
entered on the reverse side
under «Subsistence/allowance
with overnight stay», TT code
1086/1087/1052

Subsistence and
accommodation by voucher
Enter here food and
accommodation expenses
documented by vouchers. If in
addition to recovering these
expenses you are entitled to a
course allowance, enter the
number of days under TT code
1057 on the front. The total
course allowance should be
entered in the «amount» column.
Total (enter on reverse side, TT-kode 1041)
5580

Overnight stay
Name and address of hotel, boarding
house, etc. (not private lodgings)

Remarks