Personal Details
Extern name	Name
Postal address	Address
Postcode	Postcode	Country of Residence	Country
Mobile phone	Mobile	Other phone (opt)	Other phone
Email address	Email
Date of birth	Date	Month	Year
PPS number	PPS number
Programme being externed	Programme	Department or Subject	Dept or Subject
Programme faculty contact	NCAD Contact	School	School
Fees
Extern Fee	Dates	Rate	Total €
Interim visit: one day only	From Date	To Date	€385	€
End-of-year visit: max two days	From Date	To Date	€385	€
Total fee	€
Expenses
€uro Expenses	Description Attach all receipts, must be itemised and legible, scans or copies acceptable.	Amount €	Total €
Accommodation Max €167 per night	Accommodation	Euro	Euro
Incidentals Max €33.60 per day, meals, snacks coffee etc	Incidentals	Euro	Euro
Travel Travel fares, parking, or motor /km mileage	Travel	Euro	Euro
Total €uro expenses to be paid	€
Foreign Currency Expenses	Description Attach all receipts, must be itemised and legible, scans or copies acceptable.	Amount	Total
Denote which currency
Accommodation Max €167 per night	Accommodation	NON-Euro	NON-Euro
Incidentals Max €33.60 per day, meals, snacks coffee etc	Incidentals	NON-Euro	NON-Euro
Travel Travel fares, parking, or motor /km mileage	Travel	NON-Euro	NON-Euro
Total foreign currency expenses to be paid

Signature
I confirm that the details in this form are correct and genuine.
External Examiner	Name	Date
Print name	Signature	Date

Bank details for bank transfer
Bank account name	Account name
Bank name	Bank name
Bank address	Address
IBAN number	IBAN
Swift/BIC code	Swift or BIC

NCAD use only
Extern Co-ordinator	Kilian O’Callaghan	Date
Print name	Signature	Date
Charge code	Cost Centre	Account Code
Travel & Subsistence	#	4	1	1	0	7
Extern Fee Total	€
€uro Expenses Total	€
Non €uro Expenses Total	Expenses	Conversion Rate	Rate	€uro equivalent	€
Total Gross Payment in €uro	€

Please send completed form to: ocallaghank@staff.ncad.ie

Contact Kilian O’Callaghan ocallaghank@staff.ncad.ie if you don’t have a Personal Public Service number.