SPECIAL TRIBUNAL FOR lEBANON

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TRIBUNAL SPECIAL POUR u lIBAN

CERTIFICATE
Name of Child

OF ATTENDANCE AND COSTS AND RECEIPT FOR PAYMENTS

Remy-Kai POrrINGER

I Paul Anthony POrrINGER

TO BE FULLY COMPLETED BY EDUCATIONAL INSTITUTIONS

Name of Staff Member

Student ID No. (if applicable)

ONI... Y

To: Educational

Institutions attended by children of Special Tribunal for Lebanon staff members.

Staff members of the Special Tribunal for Lebanon are entitled, under certain conditions, to an education grant This form has been devised to assist in determining their entitlement and in establishing the amount of the grant. Your co-operation in completing this form will be much appreciated. Please return the original to the staff member and retain a copy for your files. This may also facilitate confirmation of the information which is performed by the Special Tribunal for Lebanon on a periodic and routine basis.

School Year (day, month, year) Began: 6 September 2011

I Ended:

6 july 2012

Child attended school (day, month, year) From 6 September 2011 Child was in level classG form4

Until:

6 july 2012

Was child in full time school attendance?

IZI

Yes

Amount of non-8TL scholarships, grants, or any financial assistance:

No

Were aU textbooks provided by the school free or at no additional cost? Did the institution cbarge for lodging? If not, did the institution charge for lunch? Was daily group transportation provided by or through the institutiou?

Yes

No

0
Yes

181
No Cost Cost Cost

0
Yes

181
No

0
Yes

181
No

0
The institution charged the staff member as foUows: Admission and Registration: Tuition:

181

lAD 180,000

I Examination/Diploma

Other items required for the child at the institution. (please itemize on separate sheet if necessary and attach)

Payments were madc by the staff member to the institution as follows. Please indicate currency, amount and date of each payment. Currency, amount and date Currency, amount and date Currency, amount and date Currency, amount and date

lAD 45,000 21 AUG 2011 lAD 45,000 19 DEC 2011 lAD 45,000 21 MAR 2012
PLEASE COMPLETE ALL SECTIONS AND ENSURE THAT ANY ATTACHMENTS BY THE SIGNATORY. OR CORRECTIONS ARE INITIALLED

IMPORTANT:

SEAL of Educational

Institution

Name and Title of Officer signing on behalf of Educational Pauline Boggis Bursar

Institution

11 1/2 DUNqON ftO 0 KlNGSTON2

AI PREPAAAlqRl .~. oet

School name and address
Vaz Preparatory School 11 112Dunoon Road Kingston 2

DATE: March 28, 2012

Telephone No.
(876)9282645