seal of the Institute	Warsaw, dated

FOREIGN TRAVEL REFERRAL NO. .........../.............

to 		stay from		to		
(country, town/city)

full name: 		

home address 		

main place of work 		

address		

work phone 		fax		e-mail		

degree or academic title 		position		

scientific specialization 		passport No.		

Purpose of travel

receiving organizations 		

character of stay: **	research, training, conference, consultation, organizational, contract, lecturing, other

stay under:**	business travel, unpaid leave

stay financing:**	travel at the expense of PAS (PAS), at the expense of the receiving party (RP), at the expense of the facility – statutory activities, grant, other (EF), at own expense (OE), travel under the equal exchange of specialists (EES).

DIRECTOR		Delegate	

Costs of stay	travel allowances		hotels		
	stay allowances		entry fees		
	city transport		Total costs of stay		
Transport	airplane, train, bus, other 		class	Costs of transport	
	route: 		financed by:		
Total calculated travel expenses:		

APPLIED BY		APPROVED BY		CONFIRMED BY	

Director of the Office for Foreign Cooperation [BWZ], PAS		PAS Chancellery Head		PAS President	
*	in the case of travel to two or more countries, two or more referrals are to be completed
**	delete as appropriate