Claim Form for Conferences

CLAIM FORM FOR CONFERENCES

Please submit claim form to:

Agency For Integrated Care

Learning Institute

No. 5 Maxwell Road

#10-00 Tower Block

MND Complex

Singapore 069110

Attn: AIC Healthcare Productivity Fund Conference Secretariat

Fax No.: 6820 0735

Tel No.: 6593 3915

Email: aic.ccd@aic.sg

Letter of Award Reference no.
(refer to Conference Fee Subsidies Letter)
ILTC Institution
Is the ILTC Institution GST registered?
(If Yes, please indicate GST Registration Number) /
No Yes GST Registration Number:______
Name of Trainee & NRIC/Fin No.
Conference Title
Conference Venue/ Country
Conference Duration / days
No. of Official Working Days
Award Amount (refer to Conference Fee Subsidies Letter) / S$
Total Claim Submitted / S$
Applied for other fundings/ sponsorship? (If Yes, please indicate fundings/ sponsorship) /
No Yes Fundings/ Sponsorship: ______
Liaison person from ILTC Institution / Name: ______
Designation: ______
Contact no.: ______
Email address: ______
Claim Submission Checklist:
(Original / Certified-True-Copies of these documents must be submitted with this claim)
/ Conference Fees and Other Compulsory Fees Invoice / / Visa Fees Receipts
/ Conference Certificate of attendance / / Travel / Medical Insurance Receipts
/ Itinerary and Boarding Pass / / Post Conference Report
/ Airport Transfer Receipts

Note: For all GST registered organisations, all claim amounts should exclude GST. For non-GST registered organisations, all claim amounts should include GST.

Complete the table below.

Description / Claim Amount / Remarks / Supporting documents
(Original or certified true copies must be submitted) / Approved Claim Amount
(For Official Use Only) / Remarks (For Official Use Only)
Conference Fees / S$ / Invoice, Certificate of attendance / S$
Airfare (return, economy) / S$ / Itinerary, Boarding pass / S$
Airport transfers
(home-airport-hotel) / S$ / Receipt / S$
Visa fees / S$ / Receipt / S$
Medical insurance / S$ / Receipt / S$
Travel insurance / S$ / Receipt / S$
Per Diem (calculated by AIC Productivity Fund Conference Secretariat) / S$ / Include one day before the first day of the official conference, up to the last day of the official conference. / NA / S$
Others
(With Justification under remarks) / S$ / S$
Total Cost
(excluding Per Diem) / S$ / S$
Total Cost
(including Per Diem; to be calculated by AIC Productivity Fund Conference Secretariat) / S$ / S$
Declared by Trainee
Name
Designation
Signature / Date
Endorsed by CEO/ED/Administrator of ILTC Institution
Name
Designation
Signature / Date
Endorsed by CFO (or equivalent) of ILTC Institution
Name
Designation
Signature / Date
For Official Use only
Total Approved Claim Amount / S$
Cumulative claims received till date in this FY
(Exclude this claim) / Remaining awarded sum utilised till date in this FY
(Include this claim)
AIC Learning Institute to check and certify
Name
Designation
Signature / Date
Name of LI Manager
Signature / Date
Name of CCDD Director
Signature / Date
AIC Finance to check and approve
Name of Accountant
Signature / Date
Name of Assistant Director/ Director, Finance
Signature / Date
Remarks

Claim Form for Conference Pg 4 of 4

Version: May2013