Fund Reimbursement FY27

This is a preview of the Funds Reimbursement 27 form. When you’re ready to apply, click Fill Out Now to begin.

Invoice for payment / Course Funds Reimbursement Claim Form

* indicates a required field.

If this is an invoice/reimbursement for a medical item, please follow this link and fill out this application instead Medical Equipment and Aids Application form 26/27

Payment and Reimbursement Requirements

Invoice Payments To ensure timely payment, please ensure that the invoice is made out to GOLD COAST HOSPITAL FOUNDATION and the bank details are correct and consistent on both the application form and the invoice. A completed Director Approval Form must also be submitted.

Reimbursements Please submit all relevant receipts along with a signed Director Approval Form. The amounts listed on the receipts must match those stated on the Director Approval Form.

Payment Processing Timeframe Payments will be processed within two weeks of receiving all correctly completed documentation. Please note that any incomplete or incorrectly completed documentation may result in delays to payment.

SmartyGrants Application ID

Please enter the SmartyGrants Application ID that this reimbursement is for

Applicant *

Response required.

Individual

Organisation

Clear

Organisation Name

First name

Last name

Applicant Position *

Applicant Primary Phone Number *

Must be an Australian phone number.

Applicant Primary Email *

Must be an email address.

Applicant Department *

Course name payment is in relation to: *

Response required.

Other

Fill out question below if referring to a memorial day funded by GCHF - write see below in 'other'

GCHHS support event name

Reimbursement of Out of Pocket Expenses (Receipts) (Not Applicable)

Expenditure	$	Upload proof of purchase (receipt)
		Attach a file: Upload new fileSelect stored file Uploading Remove
		Attach a file: Upload new fileSelect stored file Uploading Remove

Must be at least 2 rows

Invoice to be paid - please ensure invoices are made out to Gold Coast Hospital Foundation (Not Applicable)

Please ensure the bank details are correct and consistent on both the application form and the invoice.

Total of all invoices

Must be a dollar amount. Enter the total amount expected to be received.

Description

Upload all Invoices *

Attach a file: Upload new file

Total amount being reimbursed and invoiced (Not Applicable)

The amounts listed on the receipts must match those stated on the Director Approval Form.

Total Expenditure Amount *

This number/amount is calculated.

Payee Details (please note only one payment can be processed for this reimbursement claim) (Not Applicable)

To ensure timely payment, please ensure that the bank details are correct and consistent on both the application form, invoice, and Directors Approval Form.

Payee Name (and Company Name if applicable) *

Account Name *

BSB *

Account Number *

Authorisation (Not Applicable)

Upload Authorisation form which has been signed off by the Department Director/Manager. Download this form here

Upload once authorised *