€ 2,00 tax stamp
ONLY for remuneration and/or reimbursement of expenses exceeding € 77,47

OCCASIONAL EMPLOYMENT 					
RECORD OF THE SERVICES PROVIDED 
FOR SEMINARS /CONFERENCES						

The undersigned _____________________________________________________________________
place of birth ______________________________________________ date of birth ______________
resident in	 _______________________________________________________ prov. ______ address _________________________________________________________________ nr. ______ post code _____________  Fiscal Code ____________________________________________________ VAT identification n. _________________________________ following the conferment of the assignment  and provision of services of __________________ to carry out the conference/s  described as follows: __________________________________________________________________________________
___________________________________________________________________________________
option 1) for which the payment of the total amount of €  _______________ gross of withholding paid by the perceiver has been agreed.
option 2) for which the payment of the total amount of € _______________ gross of withholding paid by the perceiver in addition to the following expenses*  □ travel      □ board    □ accommodation
option 3) with only the reimbursement of the following expenses*   □ travel     □ board 
□ accommodation
declares
that the above mentioned occasional service has been carried out as agreed, autonomously defining the executive procedure,
and claims
(option 1) the payment of the agreed honorarium of € _____________ gross of withholding paid by the perceiver.
or
(option 2) the payment of the agreed honorarium of € _______________ as well as reimbursement of the following expenses:
Travel expenses for a total amount of € _______________
relative to trips by [specify the vehicle] ____________________ [if travelling using own vehicle please specify the type of vehicle, brand, model and fuel, as well as the Kilometres. The eligible expense merely refers to the cost of fuel resulting from the receipts supplied and re-measured according to the kilometres based on ACI tables]:

on ____________ from __________________ to _________________ and return journey  € ________ 
on ____________ from __________________ to _________________ and return journey  € ________ 
Board expenses for a total amount of  € ______________
meal on  _______________ € _________________ c/o _____________________________________
meal on  _______________ € _________________ c/o _____________________________________
Accommodation expenses for a total amount of  € __________________
n. nights _____ from _____________ to ____________  c/o hotel _____________________________ + tourist tax   € _____
for a total amount (honorarium + expenses) of € gross of withholding paid by the perceiver 
or
(option 3) the reimbursement of the following expenses:
Travel expenses for a total amount of  € _______________ 
relative to trips by [specify the vehicle] ____________________ [if travelling using own vehicle please specify the type of vehicle, brand, model and fuel, as well as the Kilometres. The eligible expense merely refers to the cost of fuel resulting from the receipts supplied and re-measured according to the kilometres based on ACI tables]:
on ____________ from __________________ to _________________ and return journey  € ________ 
on ____________ from __________________ to _________________ and return journey  € ________ 
Board expenses for a total amount of  € ______________
meal on  _______________ € _________________ c/o _____________________________________
meal on  _______________ € _________________ c/o _____________________________________
Accommodation expenses for a total amount of € __________________
n. nights _____ from _____________ to ____________  c/o hotel _____________________________ + tourist tax   € _____
for a total amount of € _______________
The undersigned declares under his/her responsibility,
□	that he/she has not received nor will receive as such any other reimbursement of the above reported expenses.

The undersigned attaches to the present declaration the relevant documentation providing evidence of the expenses.
Florence, date ________________				   The contractor
				_________________________________
* Expenses as well as honorarium are taxed pursuant to art. 25 D.P.R. n. 600 of 1973. See also resolution n.49/E of 11 July 2013 – taxation  of expense reimbursements by the Italian Revenue Agency.

For Office use only

The reimbursement of the expenses incurred for an amount of € _____________ gross of withholding paid by the perceiver is approved (€ inclusive of charges borne by the Administration).

THE HEAD OF THE DEPARTMENT			FUND OWNER
________________________________	Prog. ___________________________

Prof. ___________________________	Prof.  ___________________________