Physical Address:
James Cook University
Traveller Creditor Details Form
Travel Expense Reimbursement Only
Country
No. & Street
Country
Postal Address:
(if different from the above)
Bank Account Name:
Bank Name:
IBAN / Account Number:
SWIFT Code:
Bank Routing Number:
Currency Code:
Full Bank Address:
(ABA Num / Sorting Code / Fedwire Num / IFSC / Transit Num)
Please only nominate a currency accepted by your bank
Country
Email Address for Remittance Advices:
No. & Street / PO Box
Creditor Authorisation (mandatory)
Full Name:
Phone Number:
Date:
Signature:
Please print, sign, scan and email completed and authorised forms to original requestor
Privacy Statement
James Cook University recognises the importance of protecting your personal information and organisation information. The University will use the information you provide
on this form for the purpose of ensuring payment of your invoices is electronically transferred to your nominated bank account. Your rights to access and amend your personal
information are set out in the Information Privacy Act 2009 (Qld) which also places obligations on the University as to how we handle your personal information. Please also
see the University’s Information Privacy Policy at https://www.jcu.edu.au/policy/corporate-governance/information-privacy-policy, for information about how to access and
amend your personal information held by the University.
City
State
Post Code
City
State
Post Code
DOMESTIC BANK ACCOUNT DETAILS
(preferred option)
Account Name:
Bank Name:
BSB Number:
Account Number:
Travellers Full Name
No. & Street
City, State and Post Code
INTERNATIONAL BANK ACCOUNT DETAILS
[Please Select]
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome