Plan Cancer
Environnement - 2017 /
TVA Intra: FR311800360 48
SIRET: 180036048 00015

INVOICE DIRECTIONS

In order to pay your expertise, bank informations are essentials.

Payments are made only on a personal account. We cannot pay on any other account as stipulate in the French Laws (e.g. a university account).

In accordance with the regulations in force, fees paid will be included in its annual tax return to the French fiscal authorities.

Contact your bank office to get more details about international bank transfer and fill correctly the Invoice.

Please note the information you need according to your country or the country of your bank account.

Country / Information requested / Country / Information requested
European countries / Full name of the account holder / Japan / Full name of the account holder
Personal Bank Name / Personal Bank Name
Bank address – City and/or State / Bank address – City and/or State
Country of the bank / Country of the bank
IBAN / Branch
SWIFT N° / Code BIC / Accountnumber
SWIFT N° / Code BIC
USA / Full name of the account holder / India / Full name of the account holder
Personal Bank Name / Personal Bank Name
Bank address – City and/or State / Bank address – City and/or State
Country of the bank / Country of the bank
Aba / Routing / Sort code
Accountnumber / IFSC Code
SWIFT N° / Code BIC / Accountnumber
SWIFT N° / Code BIC
Canada / Full name of the account holder / Others Countries / Full name of the account holder
Personal Bank Name / Personal Bank Name
Bank address – City and/or State / Bank address – City and/or State
Country of the bank / Country of the bank
Routing / Bank Code
Accountnumber / Accountnumber
SWIFT N° / Code BIC / SWIFT N° / Code BIC
Australia / Israel / France / Provide a RIB
Full name of the account holder
Personal Bank Name
Bank address – City and/or State
Country of the bank
Branch / BSB
Accountnumber
SWIFT N° / Code BIC

Please fill out the information below

NOTE D’HONORAIRES / INVOICE

PC «CANCER et ENVIRONNEMENT» N° / EXP / 17 /

Payment of fees to foreign experts for assessments or reviews scientists of files and for writing a report

Indemnisation des experts étrangers dans le cadre d’évaluation ou d’examen de dossiers, donnant lieu à la fourniture d’un rapport

IDENTIFICATION OF THE EXPERT/ Identification de l’expert

Last Name/ Nom
/
Spouse Name/ Epouse
First name / Prénom
/ Middle Name/ 2è prénom

Personaladdress /Adresse personnelle

/ Professional address/ Adresse professionnelle
Country / Pays / Country / Pays
Email

BANK INFORMATION/ Information bancaire

Personal Bank Name / Banquepersonnelle
Bank address – City and/or State / Domiciliation / Country of the bank / Pays banque
IBAN N°
SWIFT N° / Code BIC
Sort code / Aba / Routing/ BLZ / Branch / BSB / Accountnumber / Compte bancaire
Only if needed:
Intermediate Bank / Banqueintermédiaire
Account number / Comptebancaire
SWIFT N° / Code BIC

INVOICE/ Facture

Description/ Descriptif
/ Evaluation of projects /
Evaluation à distance de projets /
Fees all inclusive for 1 expertise/ Honorairesforfaitaires pour 1 expertise
/ Total
Number of project / Nombre de projet
/ 100 €

Obligatory signature of the expert /Signature obligatoire de l’expert

Drawn up at / Fait à
/
Date
Signature

Insem – DESP

101 rue de Tolbiac – 75654 Paris Cedex 13

République FrançaiseTél: +33 1 44 23 61 14 / Fax: +33 1 44 23 61 44