Réseau Européen de Formation Judiciaire European Judicial Training Network Claim for reimbursement of travel expenses (by private car) Demande de remboursement des frais de transports (en voiture privée) Date: Claim addressed to / Demande adressée à: Object of the claim / Objet de la demande: Claim for reimbursement of travel expenses associated with the Administrative Law Seminar on “HUMAN RIGHTS AN ACCESS TO JUSTICE ”, to be held at Regional Training Centre of Judicial Academy at County Court of Split, Gunduliceva 29a, 21000, Split, Croatia from 20 to 21 October 2016. NOTE: The EJTN is only able to reimburse private car journeys up to a maximum of 1.200km (return journey). Please attach to this claim a Michelin/Google Internet Map depicting your travel itinerary (arrival and departure points, as well as total number of kilometres travelled). Description de la demande / Description of the claim: Address of departure: km x 0,22€ / km = € Travel by private car: cost of 0,22 EUR per kilometre for a round trip up to a maximum of 1.200 km calculated on the basis of the shortest route (itinerary mapping in support – Michelin/Google Internet Maps), using the following formula: Kilometre claim km x 2 (in-out) x 0,22 € / km = Participants who choose to use their own car remain fully liable for any accidents to their car or to third parties. Nom et adresse / Name and address: Amount : € Date and signature: Réseau Européen de Formation Judiciaire / European Judicial Training Network (Association Internationale Sans But Lucratif / Non-profit making international organization) Rue du Commerce 123, B- 1000 Bruxelles ; Tel: +32.2.280.22.42, E-mail: [email protected]