#DMUglobal Bursary Payment Request Form

Student detailsStudent name:P number:

Student address:

Postcode:

Bank account details (UK accounts only)Bank name:

Bank address:

Postcode:Name of account holder:Sort code (6 digits):Account number (8 digits):

#DMUglobal opportunity details#DMUglobal opportunity name:(available on website)#DMUglobal opportunity reference number:(e.g. ACA-B-63-2015)

All fields are mandatory Brackets indicate where we need information to be inputted Form must be completed electronically and saved as a word doc. or docx. or equivalent Form must be saved with your full name as the file name

FOR STAFF USE ONLY- PLEASE DO NOT WRITE ANYTHING BELOW THIS LINE

Account codes Net valueSAP GL code SAP cost centre £

Line 1Line 2

Total

Prepared by: Signed: Date:

Authorised by: Signed: Date: