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{\title CLAIM FOR RESOURCE FEES, COURSE EXPENSES AND TRAVEL & SUBSISTENCE}{\author Michelle Smith}{\operator Chris}{\creatim\yr2009\mo12\dy13\hr21\min56}{\revtim\yr2009\mo12\dy13\hr21\min56}{\printim\yr2008\mo8\dy27\hr11\min36}{\version2}{\edmins0}
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\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b CLAIMANTS DETAILS}{: (Please complete in BLOCK CAPITALS)\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd 
\trqc\trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth10420 \cellx10312
\row }\trowd \trqc\trgaph108\trrh454\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth2508 \cellx2400
\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth5520 \cellx7920\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth2392 \cellx10312\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {TITLE\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {SURNAME
\cell INITIALS\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trqc\trgaph108\trrh454\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh
\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clshdng1000\cltxlrtb\clftsWidth3\clwWidth2508 \cellx2400\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth5520 \cellx7920\clvertalc\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth2392 \cellx10312\row }\trowd \trqc\trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr
\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth2508 \cellx2400\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth5520 \cellx7920\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2392 \cellx10312\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\cell \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trqc\trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2508 \cellx2400\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth5520 \cellx7920\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2392 \cellx10312\row }\trowd \trqc\trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 
\trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth10420 \cellx10312\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {ADDRESS & PHONE NUMBER\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trqc\trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth10420 \cellx10312
\row }\trowd \trqc\trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2508 \cellx2400\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7912 \cellx10312\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {Number & Street\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trqc\trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 
\trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2508 \cellx2400\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7912 \cellx10312\row }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {Town\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {
\trowd \trqc\trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2508 \cellx2400\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7912 \cellx10312\row }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {County\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trqc\trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 
\trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2508 \cellx2400\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7912 \cellx10312\row }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {Postcode\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trqc\trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2508 \cellx2400\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7912 \cellx10312\row }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {Daytime Telephone\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trqc\trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 
\trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2508 \cellx2400\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7912 \cellx10312\row }\trowd 
\trqc\trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth10420 \cellx10312
\pard\plain \s34\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \b\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {PAYMENT DETAILS\cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\trowd \trqc\trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr
\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clshdng1000\cltxlrtb\clftsWidth3\clwWidth10420 \cellx10312\row }\trowd \trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth10420 \cellx10312\pard\plain 
\s34\ql \li0\ri0\sb240\sa240\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \b\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\fs20 
Payment will be issued by NHS Shared Services by CHEQUE, or BACS if Shared Services have your bank details.
\par }\pard\plain \ql \li0\ri0\sb240\sa240\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\fs20 
If you wish to change from cheque payment to a BACS payment you should attach a typed request, on headed paper where possible, personally signed.  Please show full bank details, i.e.
 bank name, branch, sort code, account number and name(s) of the account holder(s).\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 
\trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth10420 \cellx10312\row }\trowd \trqc\trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 
\trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clshdng1000\cltxlrtb\clftsWidth3\clwWidth10420 \cellx10312\pard\plain \s34\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \b\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {CLAIMANT STATUS:}{\b0  (X appropriate box)
\cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\trowd \trqc\trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb
\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth10420 \cellx10312\row }\trowd \trqc\trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv
\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth2268 \cellx2160\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth720 \cellx2880\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth2160 \cellx5040
\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth840 \cellx5880\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth2695 
\cellx8575\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1737 \cellx10312\pard\plain \s33\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {Programme Director\cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\fs20\lang1024\langfe1024\noproof\langnp1033 {\shp{\*\shpinst\shpleft12\shptop201\shpright295\shpbottom484\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz0\shplid1026
{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn lTxid}{\sv 65536}}{\sp{\sn dxTextLeft}{\sv 0}}{\sp{\sn dyTextTop}{\sv 0}}{\sp{\sn dxTextRight}{\sv 0}}{\sp{\sn dyTextBottom}{\sv 0}}{\sp{\sn hspNext}{\sv 1026}}
{\sp{\sn wzDescription}{\sv }}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \pard\plain \s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8192\dptxbx\dptxlrtb{\dptxbxtext\pard\plain \s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}\dpx12\dpy201\dpxsize283\dpysize283\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\cell }\pard\plain 
\s33\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {Consultant\cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\fs20\lang1024\langfe1024\noproof\langnp1033 
{\shp{\*\shpinst\shpleft-98\shptop172\shpright185\shpbottom455\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz3\shplid1029{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn lTxid}{\sv 131072}}{\sp{\sn dxTextLeft}{\sv 0}}{\sp{\sn dyTextTop}{\sv 0}}{\sp{\sn dxTextRight}{\sv 0}}{\sp{\sn dyTextBottom}{\sv 0}}{\sp{\sn hspNext}{\sv 1029}}{\sp{\sn wzDescription}{\sv }}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \pard\plain 
\s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8195\dptxbx\dptxlrtb{\dptxbxtext\pard\plain \s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}\dpx-98\dpy172\dpxsize283\dpysize283\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\cell }\pard\plain 
\s33\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {Associate Advisor\cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\fs20\lang1024\langfe1024\noproof\langnp1033 
{\shp{\*\shpinst\shpleft-103\shptop172\shpright180\shpbottom455\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz6\shplid1032{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn lTxid}{\sv 196608}}{\sp{\sn dxTextLeft}{\sv 0}}{\sp{\sn dyTextTop}{\sv 0}}{\sp{\sn dxTextRight}{\sv 0}}{\sp{\sn dyTextBottom}{\sv 0}}{\sp{\sn hspNext}{\sv 1032}}{\sp{\sn wzDescription}{\sv }}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \pard\plain 
\s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8198\dptxbx\dptxlrtb{\dptxbxtext\pard\plain \s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}\dpx-103\dpy172\dpxsize283\dpysize283\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trqc\trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth2268 \cellx2160\clvertalc\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth720 \cellx2880\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth2160 \cellx5040\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth840 \cellx5880\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth2695 \cellx8575
\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1737 \cellx10312\row }\trowd \trqc\trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 
\trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrnone 
\cltxlrtb\clftsWidth3\clwWidth2268 \cellx2160\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth720 \cellx2880\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone 
\cltxlrtb\clftsWidth3\clwWidth2160 \cellx5040\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth840 \cellx5880\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone 
\cltxlrtb\clftsWidth3\clwWidth2695 \cellx8575\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1737 \cellx10312\pard\plain 
\s33\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {CME Tutor\cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\fs20\lang1024\langfe1024\noproof\langnp1033 
{\shp{\*\shpinst\shpleft12\shptop91\shpright295\shpbottom374\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz1\shplid1027{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn lTxid}{\sv 262144}}{\sp{\sn dxTextLeft}{\sv 0}}{\sp{\sn dyTextTop}{\sv 0}}{\sp{\sn dxTextRight}{\sv 0}}{\sp{\sn dyTextBottom}{\sv 0}}{\sp{\sn hspNext}{\sv 1027}}{\sp{\sn wzDescription}{\sv }}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \pard\plain 
\s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8193\dptxbx\dptxlrtb{\dptxbxtext\pard\plain \s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}\dpx12\dpy91\dpxsize283\dpysize283\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\cell }\pard\plain 
\s33\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {Patient Simulator\cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\fs20\lang1024\langfe1024\noproof\langnp1033 
{\shp{\*\shpinst\shpleft-108\shptop611\shpright175\shpbottom894\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz5\shplid1031{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn lTxid}{\sv 327680}}{\sp{\sn dxTextLeft}{\sv 0}}{\sp{\sn dyTextTop}{\sv 0}}{\sp{\sn dxTextRight}{\sv 0}}{\sp{\sn dyTextBottom}{\sv 0}}{\sp{\sn hspNext}{\sv 1031}}{\sp{\sn wzDescription}{\sv }}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \pard\plain 
\s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8197\dptxbx\dptxlrtb{\dptxbxtext\pard\plain \s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}\dpx-108\dpy611\dpxsize283\dpysize283\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}
{\shp{\*\shpinst\shpleft-108\shptop91\shpright175\shpbottom374\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz4\shplid1030{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn lTxid}{\sv 393216}}{\sp{\sn dxTextLeft}{\sv 0}}{\sp{\sn dyTextTop}{\sv 0}}{\sp{\sn dxTextRight}{\sv 0}}{\sp{\sn dyTextBottom}{\sv 0}}{\sp{\sn hspNext}{\sv 1030}}{\sp{\sn wzDescription}{\sv }}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \pard\plain 
\s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8196\dptxbx\dptxlrtb{\dptxbxtext\pard\plain \s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}\dpx-108\dpy91\dpxsize283\dpysize283\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\cell }\pard\plain 
\s33\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {Other (please specify)\cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\fs20\lang1024\langfe1024\noproof\langnp1033 
{\shp{\*\shpinst\shpleft-113\shptop91\shpright170\shpbottom374\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz7\shplid1033{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn lTxid}{\sv 458752}}{\sp{\sn dxTextLeft}{\sv 0}}{\sp{\sn dyTextTop}{\sv 0}}{\sp{\sn dxTextRight}{\sv 0}}{\sp{\sn dyTextBottom}{\sv 0}}{\sp{\sn hspNext}{\sv 1033}}{\sp{\sn wzDescription}{\sv }}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \pard\plain 
\s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8199\dptxbx\dptxlrtb{\dptxbxtext\pard\plain \s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}\dpx-113\dpy91\dpxsize283\dpysize283\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trqc\trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth2268 \cellx2160\clvertalc\clbrdrt\brdrnone 
\clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth720 \cellx2880\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth2160 \cellx5040\clvertalc\clbrdrt\brdrnone 
\clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth840 \cellx5880\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth2695 \cellx8575\clvertalc\clbrdrt\brdrnone 
\clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1737 \cellx10312\row }\trowd \trqc\trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh
\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone 
\cltxlrtb\clftsWidth3\clwWidth2268 \cellx2160\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth720 \cellx2880\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrnone \cltxlrtb\clftsWidth3\clwWidth2160 \cellx5040\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth840 \cellx5880\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4432 \cellx10312\pard\plain \s33\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {G{\*\bkmkstart Text9}P Trainer\cell 
}\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\fs20\lang1024\langfe1024\noproof\langnp1033 
{\shp{\*\shpinst\shpleft12\shptop44\shpright295\shpbottom327\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz2\shplid1028{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn lTxid}{\sv 524288}}{\sp{\sn dxTextLeft}{\sv 0}}{\sp{\sn dyTextTop}{\sv 0}}{\sp{\sn dxTextRight}{\sv 0}}{\sp{\sn dyTextBottom}{\sv 0}}{\sp{\sn hspNext}{\sv 1028}}{\sp{\sn wzDescription}{\sv }}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \pard\plain 
\s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8194\dptxbx\dptxlrtb{\dptxbxtext\pard\plain \s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}\dpx12\dpy44\dpxsize283\dpysize283\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\cell }\pard\plain 
\s33\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {GP Principal\cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\cell }{\fs22 {\*\bkmkend Text9}\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trqc\trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth2268 \cellx2160\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth720 \cellx2880\clvertalc\clbrdrt\brdrnone \clbrdrl
\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth2160 \cellx5040\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth840 \cellx5880\clvertalc\clbrdrt\brdrnone 
\clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4432 \cellx10312\row }\trowd \trqc\trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr
\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clshdng1000\cltxlrtb\clftsWidth3\clwWidth10420 \cellx10312\pard\plain \s34\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \b\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {TYPE OF CLAIM:}{\b0  ( X all that apply)}{
\cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\trowd \trqc\trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb
\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth10420 \cellx10312\row }\trowd \trqc\trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 
\trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth5148 \cellx5040
\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth840 \cellx5880\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth4432 \cellx10312\pard\plain \s33\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {RESOURCE FEE\cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\fs20\lang1024\langfe1024\noproof\langnp1033 
{\shp{\*\shpinst\shpleft-39\shptop147\shpright244\shpbottom430\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz8\shplid1034{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn lTxid}{\sv 589824}}{\sp{\sn dxTextLeft}{\sv 0}}{\sp{\sn dyTextTop}{\sv 0}}{\sp{\sn dxTextRight}{\sv 0}}{\sp{\sn dyTextBottom}{\sv 0}}{\sp{\sn hspNext}{\sv 1034}}{\sp{\sn wzDescription}{\sv }}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \pard\plain 
\s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8200\dptxbx\dptxlrtb{\dptxbxtext\pard\plain \s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}\dpx-39\dpy147\dpxsize283\dpysize283\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\cell }\pard\plain 
\s33\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {Please fill in Part A overleaf\cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\trowd \trqc\trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 
\trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrnone 
\cltxlrtb\clftsWidth3\clwWidth5148 \cellx5040\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth840 \cellx5880\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4432 \cellx10312\row }\trowd \trqc\trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth5148 \cellx5040\clvertalc\clbrdrt\brdrnone 
\clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth840 \cellx5880\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4432 \cellx10312\pard\plain 
\s33\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {BACKFILL PAYMENT\cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\fs20\lang1024\langfe1024\noproof\langnp1033 
{\shp{\*\shpinst\shpleft-25\shptop100\shpright258\shpbottom383\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz9\shplid1035{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn lTxid}{\sv 655360}}{\sp{\sn dxTextLeft}{\sv 0}}{\sp{\sn dyTextTop}{\sv 0}}{\sp{\sn dxTextRight}{\sv 0}}{\sp{\sn dyTextBottom}{\sv 0}}{\sp{\sn hspNext}{\sv 1035}}{\sp{\sn wzDescription}{\sv }}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \pard\plain 
\s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8201\dptxbx\dptxlrtb{\dptxbxtext\pard\plain \s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}\dpx-25\dpy100\dpxsize283\dpysize283\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\cell }\pard\plain 
\s33\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {Please fill in Part B overleaf\cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\trowd \trqc\trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 
\trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrnone 
\cltxlrtb\clftsWidth3\clwWidth5148 \cellx5040\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth840 \cellx5880\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4432 \cellx10312\row }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs22 REIMBURSEMENT OF COURSE FEES PAID\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs20\lang1024\langfe1024\noproof\langnp1033 
{\shp{\*\shpinst\shpleft-25\shptop53\shpright258\shpbottom336\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz10\shplid1036{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn lTxid}{\sv 720896}}{\sp{\sn dxTextLeft}{\sv 0}}{\sp{\sn dyTextTop}{\sv 0}}{\sp{\sn dxTextRight}{\sv 0}}{\sp{\sn dyTextBottom}{\sv 0}}{\sp{\sn hspNext}{\sv 1036}}{\sp{\sn wzDescription}{\sv }}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \pard\plain 
\s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8202\dptxbx\dptxlrtb{\dptxbxtext\pard\plain \s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}\dpx-25\dpy53\dpxsize283\dpysize283\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\cell }{\fs22 Please fill in Part C overleaf\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trqc\trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv
\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth5148 \cellx5040\clvertalc
\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth840 \cellx5880\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4432 \cellx10312\row 
}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs22 TRAVEL EXPENSES & SUBSISTENCE\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs20\lang1024\langfe1024\noproof\langnp1033 
{\shp{\*\shpinst\shpleft-14\shptop13\shpright269\shpbottom296\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz11\shplid1037{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn lTxid}{\sv 786432}}{\sp{\sn dxTextLeft}{\sv 0}}{\sp{\sn dyTextTop}{\sv 0}}{\sp{\sn dxTextRight}{\sv 0}}{\sp{\sn dyTextBottom}{\sv 0}}{\sp{\sn hspNext}{\sv 1037}}{\sp{\sn wzDescription}{\sv }}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \pard\plain 
\s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8203\dptxbx\dptxlrtb{\dptxbxtext\pard\plain \s38\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\par }}\dpx-14\dpy13\dpxsize283\dpysize283\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs22 Please fill in Part D overleaf\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trqc\trgaph108\trrh567\trleft-108\trkeep\trbrdrt
\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrnone 
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth5148 \cellx5040\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth840 \cellx5880\clvertalc\clbrdrt
\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4432 \cellx10312\row }\trowd \trqc\trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr
\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone 
\cltxlrtb\clftsWidth3\clwWidth5148 \cellx5040\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth5272 \cellx10312\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs22 OTHER, PLEASE SPECIFY\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs22 \cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trqc\trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv
\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth5148 \cellx5040\clvertalc
\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth5272 \cellx10312\row }\pard \ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {
\par }\pard \ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\sect }\sectd \margtsxn1021\linex0\headery567\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl {\header \pard\plain \s31\ql \li0\ri0\widctlpar
\tqc\tx4153\tqr\tx8306\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\b\fs20 CLAIM FOR RESOURCE FEES, COURSE EXPENSES AND TRAVEL & SUBSISTENCE
\par }}{\footer \pard\plain \s25\ql \li0\ri0\widctlpar\tqr\tx10080\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs16\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\lang1033\langfe1033\langnp1033 \tab }{\field{\*\fldinst {\cs36  PAGE }}{\fldrslt 
{\cs36\lang1024\langfe1024\noproof 2}}}{
\par }}\trowd \trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clshdng1000\cltxlrtb\clftsWidth3\clwWidth10428 \cellx10320\pard\plain \s34\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \b\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {DETAILS OF CLAIM\cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\trowd \trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr
\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth10428 \cellx10320\row }\trowd \trgaph108\trrh454\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2163 \cellx2055
\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth8265 \cellx10320\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {EVENT/ACTIVITY\cell 
}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trgaph108\trrh454\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 
\trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2163 \cellx2055\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth8265 \cellx10320\row }\trowd 
\trgaph108\trrh454\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2163 \cellx2055
\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth8265 \cellx10320\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {LOCATION\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trgaph108\trrh454\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb
\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2163 \cellx2055\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth8265 \cellx10320\row }\trowd 
\trgaph108\trrh454\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2163 \cellx2055
\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4265 \cellx6320\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth4000 \cellx10320\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {DATE(S)\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {From: }{\field{\*\fldinst {
{\*\bkmkstart Text13} FORMTEXT }{{\*\datafield 0010000000000000065465787431330000000a64642f4d4d2f79797979000000000000000000}{\*\formfield{\fftype0\fftypetxt2{\*\ffname Text13}{\*\ffformat dd/MM/yyyy}}}}}{\fldrslt {\lang1024\langfe1024\noproof \u8194\'20
\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{{\*\bkmkend Text13}\cell To: }{\field{\*\fldinst {{\*\bkmkstart Text15} FORMTEXT }{{\*\datafield 0010000000000000065465787431350000000a64642f4d4d2f79797979000000000000000000}{\*\formfield{\fftype0\fftypetxt2
{\*\ffname Text15}{\*\ffformat dd/MM/yyyy}}}}}{\fldrslt {\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{{\*\bkmkend Text15}\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd 
\trgaph108\trrh454\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2163 \cellx2055
\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4265 \cellx6320\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth4000 \cellx10320\row }\trowd \trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone 
\clshdng1000\cltxlrtb\clftsWidth3\clwWidth3734 \cellx3626\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth4275 \cellx7901\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\pard\plain \s34\qc \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\b\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {PART A\cell }\pard \s34\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {Resource Fees\cell }\pard 
\s34\qc \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {Amount Claimed\cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\trowd 
\trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone 
\clshdng1000\cltxlrtb\clftsWidth3\clwWidth3734 \cellx3626\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth4275 \cellx7901\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\row }\trowd \trgaph108\trrh454\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 
\trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrnone \cltxlrtb\clftsWidth3\clwWidth3734 \cellx3626\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4275 \cellx7901\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\cell }\pard\plain 
\s23\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {Resource Fee \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\b \'a3}{\field{\*\fldinst {{\*\bkmkstart Text14} FORMTEXT }{{\*\datafield 00080000000000000654657874313400000004302e3030000000000000000000}{\*\formfield{\fftype0\fftypetxt1{\*\ffname Text14}
{\*\ffformat 0.00}}}}}{\fldrslt {\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{{\*\bkmkend Text14}\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd 
\trgaph108\trrh454\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3734 
\cellx3626\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4275 \cellx7901\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\row }\trowd \trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone 
\clshdng1000\cltxlrtb\clftsWidth3\clwWidth3734 \cellx3626\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth4275 \cellx7901\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\pard\plain \s34\qc \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\b\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {PART B\cell }\pard \s34\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {Backfill Payment\cell \cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\trowd \trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr
\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrnone \clshdng1000\cltxlrtb\clftsWidth3\clwWidth3734 \cellx3626\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth4275 \cellx7901\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\row }\trowd \trgaph108\trrh454\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb
\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3734 \cellx3626\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4275 \cellx7901\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {Backfill Payment\cell }{\b \'a3}{\field{\*\fldinst { FORMTEXT }{{\*\datafield 00080000000000000654657874313400000004302e3030000000000000000000}{\*\formfield{\fftype0\fftypetxt1
{\*\ffname Text14}{\*\ffformat 0.00}}}}}{\fldrslt {\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd 
\trgaph108\trrh454\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3734 
\cellx3626\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4275 \cellx7901\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\row }\trowd \trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone 
\clshdng1000\cltxlrtb\clftsWidth3\clwWidth3734 \cellx3626\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth4275 \cellx7901\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\pard\plain \s34\qc \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\b\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {PART C\cell }\pard \s34\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {Course Reimbursement\cell \cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\trowd \trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr
\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrnone \clshdng1000\cltxlrtb\clftsWidth3\clwWidth3734 \cellx3626\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth4275 \cellx7901\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\row }\trowd \trgaph108\trrh454\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb
\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3734 \cellx3626\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4275 \cellx7901\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {Course Fees Paid\cell }{\b \'a3}{\field{\*\fldinst { FORMTEXT }{{\*\datafield 00080000000000000654657874313400000004302e3030000000000000000000}{\*\formfield{\fftype0\fftypetxt1
{\*\ffname Text14}{\*\ffformat 0.00}}}}}{\fldrslt {\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd 
\trgaph108\trrh454\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3734 
\cellx3626\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4275 \cellx7901\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\row }\trowd \trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone 
\clshdng1000\cltxlrtb\clftsWidth3\clwWidth3734 \cellx3626\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \clshdng1000\cltxlrtb\clftsWidth3\clwWidth4275 \cellx7901\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\pard\plain \s34\qc \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\b\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {PART D\cell }\pard \s34\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {Travel Expenses\cell }\pard 
\s34\qc \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\trowd 
\trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone 
\clshdng1000\cltxlrtb\clftsWidth3\clwWidth3734 \cellx3626\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \clshdng1000\cltxlrtb\clftsWidth3\clwWidth4275 \cellx7901\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\row }\trowd \trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 
\trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrnone 
\cltxlrtb\clftsWidth3\clwWidth2163 \cellx2055\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3945 \cellx6000\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr
\brdrnone \cltxlrtb\clftsWidth3\clwWidth600 \cellx6600\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3712 \cellx10312\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {Travelled from:\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\field{\*\fldinst {{\*\bkmkstart Text16} FORMTEXT }{{\*\datafield 
00000000140000000654657874313600000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text16}}}}}{\fldrslt {\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{{\*\bkmkend Text16}\cell To:\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\field{\*\fldinst {{\*\bkmkstart Text17} FORMTEXT }{{\*\datafield 00000000140000000654657874313700000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname 
Text17}}}}}{\fldrslt {\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{{\*\bkmkend Text17}\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b \trowd 
\trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth2163 \cellx2055
\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3945 \cellx6000\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth600 
\cellx6600\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3712 \cellx10312\row }\trowd \trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb
\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3348 \cellx3240\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4661 \cellx7901
\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\pard\plain \s34\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\b\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {Public Transport\cell }\pard\plain \s23\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\fs20 Mode of tr
ansport: }{\field{\*\fldinst {\fs20 {\*\bkmkstart Text23} FORMTEXT }{\fs20 {\*\datafield 00000000140000000654657874323300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text23}}}}}{\fldrslt {\fs20\lang1024\langfe1024\noproof 
\u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20 {\*\bkmkend Text23}\cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\b \'a3}
{\field{\*\fldinst {{\*\bkmkstart Text20} FORMTEXT }{{\*\datafield 00080000000000000654657874323000000004302e3030000000000000000000}{\*\formfield{\fftype0\fftypetxt1{\*\ffname Text20}{\*\ffformat 0.00}}}}}{\fldrslt {\lang1024\langfe1024\noproof \u8194\'20
\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{{\*\bkmkend Text20}\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb
\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3348 \cellx3240\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4661 \cellx7901
\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\row }\trowd \trgaph108\trrh454\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb
\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3348 \cellx3240\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth4661 \cellx7901\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\pard\plain \s34\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\b\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {Private Transport\cell }\pard\plain \s23\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\cell \cell 
}\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\trowd \trgaph108\trrh454\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 
\trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3348 \cellx3240\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth4661 \cellx7901\clvertalc\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\row }\trowd \trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh
\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3348 \cellx3240\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4661 \cellx7901\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\pard\plain \s23\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\i\fs20 (Mileage allowance 23p per mile)}{\cell }\pard \s23\ql \li0\ri0\widctlpar\intbl\tx3372\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs20 Total number of miles: }{\field{\*\fldinst {
\fs20 {\*\bkmkstart Text18} FORMTEXT }{\fs20 {\*\datafield 00080000000000000654657874313800000004302e3030000000000000000000}{\*\formfield{\fftype0\fftypetxt1{\*\ffname Text18}{\*\ffformat 0.00}}}}}{\fldrslt {\fs20\lang1024\langfe1024\noproof \u8194\'20
\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20 {\*\bkmkend Text18} \tab @ 23p/mile\cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\b \'a3}
{\field{\*\fldinst {{\*\bkmkstart Text21} FORMTEXT }{{\*\datafield 00080000000000000654657874323100000004302e3030000000000000000000}{\*\formfield{\fftype0\fftypetxt1{\*\ffname Text21}{\*\ffformat 0.00}}}}}{\fldrslt {\lang1024\langfe1024\noproof \u8194\'20
\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{{\*\bkmkend Text21}\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb
\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3348 \cellx3240\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4661 \cellx7901
\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\row }\trowd \trgaph108\trrh615\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb
\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3348 \cellx3240\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4661 \cellx7901
\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\pard\plain \s23\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\i\fs20 (Passenger allowance* 2p per passenger per mile)}{\cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\tx3372\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\fs20 Names of passengers: }{\field{\*\fldinst {\fs20 {\*\bkmkstart Text19} FORMTEXT }{\fs20 {\*\datafield 00000000000000000654657874313900000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0{\*\ffname Text19}}}}}{\fldrslt {\fs20\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20 {\*\bkmkend Text19} \tab @ 2p/mile}{\i\fs20 \cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b \'a3}{\field{\*\fldinst {{\*\bkmkstart Text22} FORMTEXT }{{\*\datafield 00080000000000000654657874323200000004302e3030000000000000000000}{\*\formfield{\fftype0\fftypetxt1
{\*\ffname Text22}{\*\ffformat 0.00}}}}}{\fldrslt {\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{{\*\bkmkend Text22}\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd 
\trgaph108\trrh615\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3348 
\cellx3240\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4661 \cellx7901\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\row }\trowd \trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3348 
\cellx3240\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4661 \cellx7901\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\pard\plain \s34\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \b\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {Subsistence\cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\fs20 Details: }{\field{\*\fldinst {\fs20 {\*\bkmkstart Text24} FORMTEXT }{\fs20 {\*\datafield 
00000000140000000654657874323400000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text24}}}}}{\fldrslt {\fs20\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20 {\*\bkmkend Text24}\cell }{\b 
\'a3}{\field{\*\fldinst {{\*\bkmkstart Text25} FORMTEXT }{{\*\datafield 00080000000000000654657874323500000004302e3030000000000000000000}{\*\formfield{\fftype0\fftypetxt1{\*\ffname Text25}{\*\ffformat 0.00}}}}}{\fldrslt {\lang1024\langfe1024\noproof 
\u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{{\*\bkmkend Text25}\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs20 \trowd \trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3348 \cellx3240\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth4661 \cellx7901\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\row }\trowd \trgaph108\trrh567\trleft-108\trkeep\trbrdrt
\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 
\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3348 \cellx3240\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth4661 
\cellx7901\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrdb\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\pard\plain \s34\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\b\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\cell }\pard \s34\qr \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs22 TOTAL AMOUNT OF CLAIM\cell }\pard 
\s34\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\'a3}{\field{\*\fldinst {{\*\bkmkstart Text26} FORMTEXT }{{\*\datafield 00080000000000000654657874323600000004302e3030000000000000000000}{\*\formfield{\fftype0\fftypetxt1
{\*\ffname Text26}{\*\ffformat 0.00}}}}}{\fldrslt {\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{{\*\bkmkend Text26}\cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\b\fs20 \trowd \trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10428\trftsWidthB3\trftsWidthA3\trwWidthA8\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3348 \cellx3240
\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth4661 \cellx7901\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrdb\brdrw10 \clbrdrr\brdrnone 
\cltxlrtb\clftsWidth3\clwWidth2411 \cellx10312\row }\pard\plain \s23\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\i\fs20 
*Passengers must be travelling to same event & also be entitled to reimbursement of travel expenses by the Deanery.
\par }\pard\plain \s34\qc \li0\ri0\sb60\sa60\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \b\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\fs22 ALL CLAIMS MUST BE ACCOMPANIED BY RECEIPTS
\par }\trowd \trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth10420 \cellx10312\pard \s34\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {
CLAIMANT DECLARATION\cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\trowd \trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 
\trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth10420 \cellx10312\row }\trowd \trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth10420 \cellx10312\pard 
\ql \li0\ri0\sb120\sa120\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs20 I hereby request payment of this claim totalling \'a3}{\field{\*\fldinst {\b\fs20 {\*\bkmkstart Text27} FORMTEXT }{\b\fs20 {\*\datafield 
00080000000000000654657874323700000004302e3030000000000000000000}{\*\formfield{\fftype0\fftypetxt1{\*\ffname Text27}{\*\ffformat 0.00}}}}}{\fldrslt {\b\fs20\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20 
{\*\bkmkend Text27} .  I declare that the expenses claimed were necessary and correctly incurred.\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth10420 \cellx10312\row }\trowd \trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalb\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth1068 \cellx960\clvertalb\clbrdrt\brdrnone \clbrdrl\brdrnone 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth6360 \cellx7320\clvertalb\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth960 \cellx8280\clvertalb\clbrdrt\brdrnone \clbrdrl
\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2032 \cellx10312\pard \ql \li0\ri0\sb120\sa120\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {Signed:\cell }\pard 
\ql \li0\ri0\sb120\sa120\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {______________________________________________\cell }\pard \ql \li0\ri0\sb120\sa120\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {Dated:\cell }\pard 
\ql \li0\ri0\sb120\sa120\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {_____________\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trgaph108\trrh567\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalb\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrnone \cltxlrtb\clftsWidth3\clwWidth1068 \cellx960\clvertalb\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth6360 \cellx7320\clvertalb\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth960 \cellx8280\clvertalb\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2032 \cellx10312\row }\pard\plain 
\s34\ql \li0\ri0\sb120\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \b\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\fs22 PLEASE RETURN COMPLETED FORMS (with receipts) TO:
\par }\pard \s34\ql \li0\ri0\sb120\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs16 
\par }\pard\plain \ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\b WENDY BUCH, 
\par }\pard \ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\b POSTGRADUATE SERVICES, FRIARAGE HOSPITAL, NORTHALLERTON, DL61JG}{
\par }\pard\plain \s34\ql \li240\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin240\itap0 \b\f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\fs16 
\par }\trowd \trgaph108\trrh454\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 
\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth10420 \cellx10312\pard \s34\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs22 
FOR YORKSHIRE DEANERY USE ONLY\cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\fs22 \trowd \trgaph108\trrh454\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 
\trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clshdng1000\cltxlrtb\clftsWidth3\clwWidth10420 \cellx10312\row }\trowd \trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh
\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalb\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth10420 \cellx10312
\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs20 TOTAL AMOUNT OF CLAIM PAID:  \'a3}{\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b \trowd 
\trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalb
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth10420 \cellx10312\row }\trowd \trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb
\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalb\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth7312 \cellx7204\clvertalb\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3108 \cellx10312\pard 
\ql \li0\ri0\sa60\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs20 AUTHORISATION: \cell }\pard \ql \li0\ri0\sa60\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs20 DATE: \cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b \trowd \trgaph108\trrh567\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv
\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalb\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7312 \cellx7204\clvertalb\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3108 \cellx10312\row }\pard\plain \s25\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 
\f1\fs16\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\fs8 
\par }}