Please send the signed declaration form to your Middle Point consultant V2.

0
For internal use only

DECLARATION
Date : 07 June 2021
Name professional : Vijayaragavan Sakthivel
Name consultant : Martho Becht

Type of declaration Currency No. of units Unit price Total Refundable Date Total EUR * Total refundable EUR *

Commuting to/from the office - 01 May 2021 t/m 31 May 2021 EUR 1 5.99 5.99 5.99 07 June 2021 € 5.99 € 5.99
See ov-chipkaart € €
€ €
€ €
€ €
€ €
€ €
€ €
€ €
€ €
€ €
€ €
€ €
€ €
€ €
€ €
€ €
€ €
€ €
€ €
€ €
€ €
€ €
€ €
TOTAL € 5.99 € 5.99
* Conversion of currency can be calculated on oanda.com
BANK DETAILS SIGNATURE

Bank name : ABN AMRO Signature Vijayaragavan Sakthivel Signature Martho Becht
IBAN** : NL70 ABNA 0624 6825 01
Swift :
BIC :

** Payment can only be processed with a valid IBAN number

Transformatorweg 28 A1.07 | 1014 AK Amsterdam | +31(0)20-7173626 | KvK: 51745399 | www.middlepoint.nl

Specification transactions
Card number 3528 0104 9344 1469
Name V. Sakthivel
Address Abraham Kuyperlaan 75 B
Postal code 3038PE
City ROTTERDAM

Transactions
Period from 01-05-2021 Total expenses € 5.99 Including 6% VAT (before 2019)/ 9% VAT (as of 2019)
Period to 31-05-2021 Total added € 0.00

Date Check-in Carrier Departure Check-out Destination Amount Transaction Product

06-05-2021 RET Tjalklaan 09:22 Beukelsdijk € 1.39 Check-out
06-05-2021 RET Rotterdam Centraal perron DD 19:23 Tjalklaan € 1.53 Check-out
20-05-2021 RET Tjalklaan 09:15 Rotterdam Centraal € 1.54 Check-out
20-05-2021 RET Rotterdam Centraal perron DD 19:22 Tjalklaan € 1.53 Check-out





















This form meets the requirements of the Dutch Tax Administraton.

Date 07-06-2021 Page 1/1