Afregning til Depressionsforeningen

Fra …………………………………..……bankreg.nr…………bankkontonr……………………..

Rejser

1)Dato ………….anledning……………..…………………….………

Fra/til …………..………..…/…….………………retur: ja/nej.………

(egen bil) …………..km a kr. 1.80…………………       kr……………..

(anden transport) …………………………………        kr……………..

…………..………………………………….……..       kr………………

I alt rejse:                                                                         kr.___________  Konto nr.___________

                                                                                                                                   Udfyldes af kasserer

Mødeudgifter

Dato……………   anledning………………….

…………………………………………………           kr.………………

…………………………………………………           kr………………

I alt mødeudgift:……………………………….           kr.____________ Konto nr.____________

                                                                                                                                   Udfyldes af kasserer

Udlæg eller andre udgifter til refusion

…………………………………………………           kr_____________Konto nr.____________

                                                                                                                                    Udfyldes af kasserer

………………………………………………….          kr.____________Konto nr.____________

                                                                                                                                    Udfyldes af kasserer

………………………………………………….          kr._____________Konto nr.____________

                                                                                                                                    Udfyldes af kasserer

………………………………………………….          kr._____________Konto nr.____________

                                                                                                                                    Udfyldes af kasserer

I alt bedes sendt mig                                                   kr._____________Bilag er vedhæftet

…………………………………….        …………………………….    ………………………

                 Underskrift                                          Godkendelse                         Kasserer