Department of English Student Exchange Scholarships
for Outbound Exchange Students
APPLICATION FOR REIMBURSEMENT

Please note that all claims must be made within TWO MONTHS upon return from the
exchange programme.

Students who wish to claim the remaining balance of the Scholarship must complete the
following:
1. Particulars of Approved Applicant
Student Name (Male/Female)
:
Student Number
:
Programme of your study
:
Cohort
:
Department
:
Partner Institution
:
Country
:
Exchange Period
:
 Semester A 200___ / 200___
 Semester B 200___ / 200___
2. Expenditure
Item
Expenditure
Description
1
Traveling
Air Ticket
1
Airport Tax
2
2
Accommodation
Receipt
Ref No.
Amount in
Foreign
Currency
Exchange
Rate
Amount in
HKD
Total
.00
Total
.00
1
2
P. 1
Item
Expenditure
Description
Receipt
Ref No.
3
Living Expenses
1
Meal
2
Daily Necessities
3
Local Traveling
4
etc.
5
Amount in
Foreign
Currency
Exchange
Rate
Amount in
HKD
6
7
4
Others
Books & Stationery
1
Heavy Winter Clothing
2
Injection Fee
3
Insurance
4
Internet Charge
5
Local Telephone Call
6
Parcel Delivery Charge
7
Passport/Visa Entry Fee
8
Total
.00
Total
.00
9
10
Grand Total in HKD
.00
Note:
1
The above completed summary should be duly signed.
2.
The original receipts should be submitted together the application form for the release of balance of
scholarship.
3.
Please fill in the amount in each row as per individual official receipt.
If there in no supporting receipt, please
mark “No receipt/Receipt lost”.
4.
Please mark the receipt reference no. on each receipt. (e.g. item 1.1, item 2.2 etc.)
5.
Disallowable items:
*Equipment (e.g. notebook computer, digital camera)
*Expenses for entertainment, sight-seeing
*Expenses for international phone calls, internet roaming
*Souvenir
P. 2
3. The amount of the scholarship I was entitled to receive is HK$______________.
The remaining amount to be claimed is HK$______________.
4. Declaration
I confirm that the expenditure stated at Section 2 was actually and necessarily incurred in connection with the
Exchange Programme.

Relevant receipts of expenditure are attached.

Academic transcript of the partner institution is attached.
Requested by:
__________________________________
______________________
Name of Student
Date
Checked and endorsed by:
___________________________________
______________________
Department of English
Date
P. 3