2026 - Hockey NSW State Teams - Officials Reimbursement Form

HNSW State Teams 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 (minimum 10km) E.G - Sydney Olympic Park > Moorebank > Sydney Olympic Park Total Kms = 45.2 Cost = $0.35 x 45.2 = $15.82

From: Starting Location

To: Event Location

Return to Starting Location?

Are you returning to the same starting location

Alternative return location

From Event to a different location

Total KMs

Total Amount

Meals = Up To $40 per day Breakfast - $10 per day Lunch - $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.

OTHER

Details of Reimbursement (Other)

Meals = Up To $40 per day Breakfast - $10 per day Lunch - $10 per day Dinner - $20 per day You are unable to claim any meals that are provided by Hockey NSW.

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.

Choose file...

Max 5MB

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