G12 Form

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FORM G12

APPLICATION FORM FOR REFUND UNDER


FOREIGN EXPERTISE SCHEME

SECTION 1 : TRAINING CENTRE

1.1 Name of MQA registered Training Centre: ………………………………………………………


.........................................................................................................................................................

1.2 Registered Address: ………………………………………………………………………………


…………………………………………………………………………………………………….

1.3 Tel: ……………………….. Fax: ……………………… E-mail: ……………………….............

SECTION 2 : COURSE DETAILS

2.1 Course Title: …………………………………………………………………………………….

2.2 Course Dates: ……………………………………………………………………………………

2.3 Total Cost: ……………………………………………………………………………………….

SECTION 3 : BANK DETAILS

3.1 Name of Bank: ……………………….…………………………………………..……………..

3.2 Branch: ……………………………….……………………………………..……………………

3.3 Account Name:…………………………………………………………………………….……..

3.4 Account Number: ………………………………………………………………………………..

HRDC, 4th Floor, NG Tower, Ebene Cybercity 72201


Tel: 454 4009 | Fax: 454 6220 / 454 6260 | Website: www.hrdc.mu
FORM G12

SECTION 4 : DECLARATIONS

We declare that the facts stated in this application and the accompanying information are true and correct
to the best of our knowledge and that we have not withheld/distorted any material fact. We also declare that
we have not benefited from the HRDC-Inhouse Training Scheme for the same course/workshop/
seminar/conference.

We understand that if we obtain the grant by false or misleading statements, the HRDC may, at its
discretion,
1 Withdraw the grant and recover immediately from us any amount of the grant that may have
been disbursed.
2 Take any other action deemed necessary.

…………………………….. ………………………
Name Designation

…………………………………. ………………………….
Signature Date & Company seal

SECTION 5 DOCUMENTS TO BE SUBMITTED

DOCUMENTS ENCLOSED (please tick as appropriate)


1 Original invoice(s) and receipt(s) duly signed and stamped of the following :
(i) Cost of economy air fare of the Trainer/E-Ticket (Please attach the
Itinerary details)
(ii) Cost of accommodation of the Trainer
(iii) Trainer Fee
(iv) Rental cost of venue (Excluding Tea/Lunch breaks)
(All refunds are VAT excluded)
2 Copy of
(i) Extract of bank statement if payment is done by cheque evidencing the
cheque has been cleared by the bank. OR
(ii) Bank remittance if payment is effected through bank transfer or
If payment is done in foreign currency
Note : Cash payment shall not be entertained for refund
3 3 Return of actual Income and expenditures of the course supported by signed
4 attendance, NIC number of participants and names of sponsoring employers
(Printed on RTI letter head with the official seal)
4 Copy of MQA/HEC course approval (if not submitted with G11 application form)
5 List of course materials
Application form and relevant documents should be sent by post or hand delivery to the HRDC.
All photocopies should be certified true copies of the originals. .
Please note that all sections of the application must be completed and accompanied by the above
documents, failing which your application will not be considered.
HRDC, 4th Floor, NG Tower, Ebene Cybercity 72201
Tel: 454 4009 | Fax: 454 6220 / 454 6260 | Website: www.hrdc.mu

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