Version définitive du 30.05.2013/CIES

Centre International d'Étude du Sport

Avenue du Peyrou 1

CH-2000 Neuchâtel

Total amount to be paid

Fees Form Amounts up to CHF 2'300.- are not subjected to social security contributions

Place and date

Beneficiary's information

Country :

For Swiss beneficiaries :

Dates Fees details Amount in CHFOther currencies Account n°

(For internal use)

RESPONSIBLE VISA

HR VISA

DATE OF RECEPTION

Lase name :

First name :

Address :

City, ZIP code :

Bank name :

Bank address + City :

Account number :

IBAN (obligatory) :

Swift code :N° AVS :

Date of birth : (obligatory)

TOTAL AMOUNT

The fees up to CHF 2'300.- are not subjected to Swiss social security contributions nor accident insurance. Swiss beneficiaries must have their own insurance. If the total amount exceeds CHF 2'300.-, this will be considered as an occasional salary and will be subjected to standard social security contributions as well as accident insurance.

Important information

Currency desired

(for Swiss beneficiaries only)