UNIVERSITÀ DEGLI STUDI DI BRESCIA
DIPARTIMENTO DI ECONOMIA E MANAGEMENT
Via San Faustino, 74/B - 25122 BRESCIA
Codice Fiscale 98007650173 - Partita IVA 01773710171
COST Action TD1306 New Frontiers of Peer
Review
Declaration for claim reimbursement
(to be filled and sent to [email protected] or uploaded to your
claim on the ecost system)
Name and Surname: ________________________________________
Date and Place of Birth: ______________________________________
Full address of residence: ____________________________________
District _______________________
ZipCode ______________
Country _______________
Phone number: _____________________________________________
Passport number ____________________
(please include a scanned copy of your pass)
Date:
Signature
Dip.to Economia e Management, Servizi Amministrativi – Via San Faustino, 74/B 25122 Brescia – [email protected]
