Reimbursement Claim Form

Company

This field is for validation purposes and should be left unchanged.

Name(Required)

Surname(Required)

Gender

Email(Required)

Telephone (00 + country code)(Required)

Fiscal Code(Required)

Course(Required)

Select the degree course you are attending.

Project(Required)

Select the degree course you are attending.

Attending year(Required)

Student number(Required)

Country of destination(Required)

Starting date

Ending date

Attending institution(Required)

Please fill in the following section if you would like to claim your reimbursement.

City of birth(Required)

Country of birth(Required)

Date of birth(Required)

Residence address (italian address for foreign students)(Required)

Street Adress (without number) Street Adress Number City (written in Italian; e.g., write “Milano”, not “Milan”) Province ZIP / Postal Code Country

Domicile address (if different from residence)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

IBAN code(Required)

The bank account has to be registered in the student's name.

For foreign bank account

BIC code SWIFT code

Allowance(Required)