Match Official Reimbursement Request

Match Official Reimbursement Request
BALMAIN & DISTRICT FOOTBALL CLUB

Manager Reimbursement Request Form
1. Retain all Match Official Signature Sheets. We recommend that you photograph the form each week in case of loss.
2. Ensure you keep copies of all documents until you have received reimbursement.
3. Reimbursement Requests will only be accepted when supported by signed Match Official Signature Sheets.
4. Reimbursement Requests will be processed monthly - please do not submit requests after each individual match.
5. Each reimbursement claim can accommodate upto six matches. To claim for more than six matches, simply submit additional forms.
6. All reimbursement requests for games taking place before 31 August 2023 must be submitted by 30 September 2023. Late submissions will not be accepted.
7. For games occurring after 31 August 2023, such as Champion of Champions, reimbursement requested must be submitted by 31 October 2023.
NO EXCEPTIONS TO THE ABOVE WILL BE ENTERTAINED

Match officials' fees are a significant expense for the Club and must be well managed and auditable.
Team & Manager Details
Claimant Name*

First NameLast Name
Team Code*
Phone Number*

Area CodePhone Number
E-mail*
Bank Account to be Reimbursed
Account Name*
Name of account reimbursement is to be credited to
BSB*
Enter as a six digit number with no hyphen
Account #*
Match Official Rates
Referee $20 / Assistant $10 (U13 - U14)Referee $25 / Assistant $15 (U15 - U16)Referee $30 / Assistant $15 (U17 - U18)Referee $35 / Assistant $17 (U21, WIL, AA, O35, O45)Referee $40 / Assistant $20 (BBC, AAW1)
Match Details & Amount Claimed
Claim 1
Round #*
Date of Match*

MonthDayYear
# of Referees*

01
# of Assistants*

012
Total Paid for Claim 1 $*
Enter in whole dollars, no decimal places
Do you wish to add another round?*

YesNo
Claim 2
Round #
Date of Match

MonthDayYear
# of Referees

01
# of Assistants

012
Total Paid for Claim 2 $
Enter in whole dollars, no decimal places
Do you wish to add another round?

YesNo
Claim 3
Round #
Date of Match

MonthDayYear
# of Referees

01
# of Assistants

012
Total Paid for Claim 3 $
Enter in whole dollars, no decimal places
Do you wish to add another round?

YesNo
Claim 4
Round #
Date of Match

MonthDayYear
# of Referees

01
# of Assistants

012
Total Paid for Claim 4 $
Enter in whole dollars, no decimal places
Do you wish to add another round?

YesNo
Claim 5
Round #
Date of Match

MonthDayYear
# of Referees

01
# of Assistants

012
Total Paid for Claim 5 $
Enter in whole dollars, no decimal places
Do you wish to add another round?

YesNo
Claim 6
Round #
Date of Match

MonthDayYear
# of Referees

01
# of Assistants

012
Total Paid for Claim 6 $
Enter in whole dollars, no decimal places
The maximum number of claims that can be submitted at one time is six. To submit more claims please complete and submit a new form.
Total Amount to be Paid $
Please ensure that the above amount is correct before submission.
Upload Signed Match Signature Sheet*

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Only claims supported by signed Match Official Signature Sheets will be paid. Cancelof
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Match Official Reimbursement Request

BALMAIN & DISTRICT FOOTBALL CLUB

Team & Manager Details

Bank Account to be Reimbursed

Match Official Rates

Match Details & Amount Claimed

Claim 1

Claim 2

Claim 3

Claim 4

Claim 5

Claim 6