REIMBURSEMENT OF EXPENSES

The undersigned

born in 						 on

DECLARES

for the event LUCANIA FILM FESTIVAL - Seventeenth EDITION - 2016 (10 to 13 August 2016) organized by the cultural "Allelammie" with registered office in Pisticci (MT) in Via Mazzini, 28, tax code 90004640778, of having held the expenses (supporting documents are attached):

MAKE PAYMENT THROUGH BANK TRANSFER ON

CC IBAN:
HEADED:
BANK + ADRESSE+ CITY:
BIC / SWIFT:

THE UNDERSIGNED

__________________

ATTACHED: COPY OF PASSPORT+ TICKET COPY+ ETC..