9th
City University of Hong Kong
PhD Student Workshop 2015 (Suzhou)
Disbursement Claim Form
[for students under the Joint PhD Mainland Collaboration Schemes]
Notes:
1. Receipt(s) with boarding pass(es) and 2 written quotations or train ticket(s), all in originals, must be provided
when submitting this form.
2. Reimbursement shall be made in Hong Kong Dollar or equivalent.
3. This form should be type written to avoid illegible hand writings, printed and signed personally
4. The completed form with relevant documents should be submitted to one of the offices of SGS below in person or
by mail by 7 July 2015. Application with missing documents or late submission shall not be processed.
Office location
Hong Kong
Suzhou
Contact Person
Miss Ivy LAM
Ms CAO Xiaoli
Ms ZHU Hong
Tel
+852 3442 9076
+86-51287161380
Email
sgworkshop@cityu.edu.hk
xiaolcao-x@my.cityu.edu.hk
hongzhu-x@my.cityu.edu.hk
Shenzhen
Ms Susan LIU
+86-75586581506
zhihliu-x@my.cityu.edu.hk
Address
香港城市大学方润华楼 4 楼
苏州工业园区独墅湖高教区仁爱
路 188 号唯真楼 317 室，邮编
215123
深圳市高新区南区粤兴一道 8 号
香港城市大学产学研大楼 504
1. Personal Particulars
Name :
CityU Student No:
Scheme: (Please mark as appropriate)
USTC-CityU Collaboration Scheme
HUST-CityU Collaboration Scheme
Department:
Contact Phone No.:
XJTU-CityU Collaboration Scheme
UCAS-CityU Collaboration Scheme
2. Workshop Details
Date of Presentation:
Title of the paper:
3. Reimbursement of Expenses Incurred
I wish to claim for the actual cost incurred for single / return* train / air* passage.
Amount Claimed RMB/HKD*
*Please delete as appropriate. The air/train ticket must have a travel date within the valid period from 4 to 10 June 2015.
4. Payment Method
Please choose one of the payment methods below and provide relevant information for reimbursement. Any extra
service charges due to incorrect or incomplete bank information or improper arrangement of the account shall be
borne by the student:
For students holding a local Hong Kong bank account:
Bank Name:
Account Holder’s Name:
Account No.:
For student holding a bank account in China [Reimbursement will be made via telegraphic transfer (T/T) in
Hong Kong Dollar equivalent. Approximately HKD250 bank service charge will be levied (subject to the bank).
Students are advised to confirm with the bank that they accept deposit via T/T before submission of this claim.] :
Bank Name:
SWIFT code:
Account Holder’s Name:
Account No. :
Bank Address:
Signature:
Date:
For internal use
To: FO
The student has fulfilled the requirements for claiming the financial support. Please check the receipts attached and
arrange for reimbursement.
Form checked by SGS: __________________________
Date: ___________________________