Particulars of Claim MEAL ALLOWANCE - STATE CHAMPIONSHIPS FOR: ___________________________________________________________________________ (full name of championships) Departure Point (town/centre): __________________________________________________ Departure day/date: _________________________________________ Time: ____________ am/pm Destination: _________________________________________________________________ Return Point (town/centre): _____________________________________________________ Return day/date: ___________________________________________ Time: _____________ am/pm NB. Delete whichever price is not applicable _________________ breakfasts @ $21.10 (city) or $18.85 (country) _________________ lunches @ $23.65 (city) or $21.55 (country) _________________ dinners @ $40.65 (city) or $37.15 (country) TOTAL AMOUNT: $____________ CERTIFICATE OF CLAIMANT I certify that the amount above is due and payable for the goods supplied or the services rendered or described above. Signature _______________________________________ Date ____________________ CERTIFICATE OF TREASURER / SENIOR EXECUTIVE OFFICER (WB School Sport Board) I certify that this payment voucher is in accordance with the particulars on the claim. Signature _______________________________________ Date ____________________ Signature _______________________________________ Date ____________________ PLEASE RETAIN A COPY OF THIS PAYMENT VOUCHER FOR TAXATION PURPOSES