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Division Form of the request for reimbursement REQUEST FOR REIMBURSEMENT (Article 14(2) and (3) of Directive (EU) 2015/637)

United Kingdom

Original text. Later amendments are not shown.

  1. 1..

    Requesting Member State's embassy or consulate

  2. 2..

    Competent embassy or consulate or Ministry of Foreign Affairs of assisted citizen's Member State of nationality

  3. 3..

    Identification of the event

    (date, place)

  4. 4..

    Data of assisted citizen(s) (to be attached separately)

    Full namePlace and date of birthName and number of the travel documentKind of assistance providedCosts
  5. 5..

    Total costs

  6. 6..

    Bank account for the reimbursement

  7. 7..

    Attachment: undertaking to repay (if applicable)