Index No.: First Name:
Middle Name:
Last Name:
Division/Section:
Duty Station:
Request travel lump-sum (amount to be determined by UNICEF travel and transportation section):
Select One
□
I request lump sum option for shipment: Amount:
Signature
Contact Admin/HR Person’s Name and Extension:
Place of recruitment is:
My city of home leave is:
My new duty station is:
My place of repatriation is: adsfadsf
Date (dd.mm.yyyy)
A cost center to fully cover the costs of this trip has been created with the following coding:
Travel dates: From: To:
(dd.mm.yyyy) (dd.mm.yyyy)
I will be traveling with the following dependants for this Official Travel:
Name Relationship Date of Birth (dd.mm.yyyy)
Signature
The staff member entitlement is: Select One
Last HL/ED Grant/Family Visit Taken (dd.mm.yyyy) :
Authorization Place:
Shipment:
Signature
Cycle
Date (dd.mm.yyyy)
Next Authorization Date HL:
(dd.mm.yyyy)
Date (dd.mm.yyyy)
Lump Sum Request for Travel and Shipment Form
UNICEF (09/09)

Initial Appointment/Reassignment/Repatriation:
The applicable air fare for the itinerary is:
Home Leave/ Education Grant/Family Visit
The full round-trip air economy as per above is:
$
$
Per adult
Per child
$
$
Per adult
Per child
Your lump sum settlement will be
$
Your lump sum settlement as indicated will be which is 100% of the applicable $ which represents 75% of full fare
Fare to the destination. (full fare as per policy)
Please indicate if this is acceptable to you and if you have any questions regarding the amount of your entitlements as outlined in CF/AI/2000-009.
I certify that the value of the lump sum travel entitlement is based on the least costly carrier and most direct route for a full fare economy ticket.
Economy. Please indicate if this is acceptable to you and if you have any questions regarding the amount of your entitlements as outlined in ST/IC/1990/13 and
CF/AI/2000-009.
I certify that the value of the lump sum travel entitlement is based on the least costly carrier and most direct route for a full fare economy ticket.
Signature Date (dd.mm.yyyy) Signature
Select
One
Option
After review I accept the lump-sum option
OR
I reject the lump-sum option and request the
purchase of individual tickets on my behalf.
Regardless of the option selected, the
staff member is required to submit the
original boarding passes and the final
copy of the used tickets.
Date (dd.mm.yyyy)
I accept this as full and final payment for my entitlements accruing on account of this travel as described in the UNICEF Regulations and Rules. (Please refer to ST/IC/1990/13 and CF/AI/2000-009 for specifics).
I agree that I will submit the Certificate by Staff Member within 10 working days of the completion of the travel. If I fail to fulfill this requirement, I am aware that the entire amount of this entitlement will be recovered from my salary.
Signature Date (dd.mm.yyyy)
Travel Authorization No.
Nicholas Lananna
Chief, TTS, UNICEF
(212) 326-7632
Date (dd.mm.yyyy)
Lump Sum Request for Travel and Shipment Form
UNICEF (09/09)