Order Number Your contact details First name * Surname * Email * Street address * Suburb / Town * State * QLD NSW VIC SA WA ACT Post Code * Phone number * Your bank details Provide your bank account details for payment BSB * Account * Event details Select tournament or other event and your role Tournament * DH McKenzie AFC#1 Robyn Chaplin Memorial AFC#2 AFC#3 AFC#4 Junior National Championships Under 15 and Cadet National Championships National Championships Other Details of any other tournament not listed Tournament start date * Referee type * Standard Senior Number of days worked * Does not include additional travel days Travel subsidy Where the AFF has not arranged travel for referees, travel costs will be subsidised to a maximum daily amount. Receipts for travel expenses must be provided. For referees where no flights are required (“Local referees”), but other travel costs are incurred, the AFF will reimburse the cost of petrol / tolls / train fares. Travel costs The amount claimed cannot exceed the daily travel subsidy multiplied by the number of days worked Supplier statement The Australian Taxation Office requires a statement from suppliers where no ABN is provided on a claim for payment. Please select one of the options below: Reason for not quoting an ABN: * The payer is not making the payment in the course of carrying on an enterprise in Australia. The supplier is an individual aged under 18 years and the payment does not exceed $350 a week. The payment does not exceed $75, excluding any goods and services tax (GST). The supply that the payment relates to is wholly input taxed The supply is made by an individual or partnership without a reasonable expectation of profit or gain. The supplier is not entitled to an ABN as they are not carrying on an enterprise in Australia. The whole of the payment is exempt income for the supplier. The supplier is an individual and the supply is made in the course or furtherance of an activity done as a private recreational pursuit or hobby Supporting information (optional) Any additional information relevant to this claim for payment Officiating payment Officiating: Travel payment Travel: Total claim Total:
