2026 HNSW State Champs Officials Reimbursement Form

PLEASE ENSURE ALL RECEIPTS AND TRAVEL DETAILS ARE PROVIDED WHEN COMPLETING YOUR REIMBURSEMENT FORM.

HNSW State Champs Officials Reimbursement Form

PERSONAL DETAILS

Name*

Phone Number*

Email Address*

Event*

Location*

Position held at event*

Date(s)*

REIMBURSEMENT OF KM

TRAVEL = $0.35/km

From: Starting Location*

To: Event Location*

Return Location*

Details of Reimbursement (From > To = Total KMs)

Please include all trip details

Total Amount

MEALS - Up to $30/day*. Breakfast/Dinner only (Lunch provided through $10 voucher at venue)

Meals = Up To $30 per day: Breakfast - $10 per day, Dinner - $20 per day. You are unable to claim any meals that are provided by Hockey NSW. i.e Vouchers,Included at Accommodation.

Details of Reimbursement (Meals)

Total Amount

OTHER

Details of Reimbursement (Other - to be pre-approved by HNSW)

Total Amount

BANK ACCOUNT DETAILS & TOTAL AMOUNT

BSB Number*

Account Number*

Name of Account*

TOTAL AMOUNT (Travel + Meals + Other)*

Have you changed your bank details since your last Hockey NSW reimbursement?*

SIGNATURE - I acknowledge that the information obtained in this form is true and correct as of the date mentioned.

Signature (Print Name)*

Date*

RECEIPTS

Please upload any receipts.*

Please ensure all receipts are uploaded.

Choose file...

Max 5MB

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