<p> UNIVERSITEIT LEIDEN FACULTY OF HUMANITIES Application form for funding of tours of duty and/or conference trips to be submitted at least 3 months in advance to the administration of your institute: = LIAS Secretariat, Nonnensteeg 1-3 ------The application is endorsed by the applicant’s personal supervisor School: …SMES / SAS Personal supervisor (name)………………………………………………………………………………………………….. # Importance of the intended trip / conference participation:………………………………………………………………….. ……………………………………………………………………………………………………………………………….. Date…………………………………………..Signature……………………………………………………………………. ------Applicant: First name(s)…………………………………………….Street name + number……………………………………………. Family name…………………………………………….Postal code + city/town…………………………………………… Bank/giro account number ………………………………………… # For PhD students a short letter of recommendation written by the supervisor must be included. Destination : * duty trip / ** conference trip - (name of the conference:………………………………………) Applicant will present a paper YES / NO (please underline the correct answer) country/countries and places to visit…………………………………………………………………………………………… Duration of the trip: Date of departure………………………………………………………………………………………. Date of arrival at the first destination………………………………………………………………….. The 1st day of the working visit/conference is a ………………… day The lst day of the working visit/conference is a …………………..day Date of return………………………………………………………….. .[ Keep this section blank ] A. Travelling expenses: Within the Netherlands euro…………… [………………………… International (plane, train, boat etc.) euro…………… [………………………… B. Accommodation expenses: Hotel costs (euro………x … nights =) euro…………… [………………………… Other costs (euro………x … days =) euro…………….[………………………… C. Other expenses: Registration fees: euro…………….[………………………… Excursions: euro…………….[………………………… Vaccinations and other costs: euro…………….[………………………… ------euro…………….[………………………… D. Expected conference receipts: From lecture fees: euro……………..[………………………… From other revenues: euro……………..[………………………… ______Total cost estimate: euro……………..[………………………… External fund applications: You are requested to apply also for travel funds for this trip at the LUF. Did you file an application at the LUF? YES / NO (a copy of any external allocations is to be added to you final Financial statement) Date…………………………………………………………….signature:………………………………………………………</p><p>Please add additional information in a brief addendum, such as: the importance of the trip/conference to applicant’s work or research; title(s) of the paper(s) to be given, or reasons why no paper will be given. </p>