F00009 Request for Reimbursement of Relocation/Resettlement Travel on Ending Employment

Instructions:

Welcome to the World Bank Group HR Forms Instructions page.

This form filler tool is designed to assist you in electronically entering your data and printing a paper form with a unique barcode corresponding to your entered data. Once you've completed your answers and printed the form, you'll need to submit it either by email or in person, depending on the form type.  Please note that the data you enter is directly captured in the form's unique barcode, so it's important that you do not make any handwritten changes, corrections, or additions to the data or to the form after it has been printed. Doing so may result in data errors and processing delays.

In case you notice any errors after printing your form, or if you've left a field blank, we recommend starting over and completing a new form. It's also important to remember that your information is not saved by the form filler and can no longer be accessed after you print it. Therefore, please be extra careful in reviewing your answers, as it is impossible to make any corrections after the form is printed.

Each form will take approximately ten minutes to complete. Please ensure you have the needed documents such as passport to extract information that may be required in some fields. Do not close the forms until they are ready for a download. Partially filled forms cannot be saved to be completed later. If you need further assistance, please contact. Thank you!

Information on Completing the Form

Please return this form to the HR Operations via (Please select one transmittal format, and submit only once):

1. Email at hroperations@worldbank.org

2. Fax (202) 522-7026

3. Interoffice mail, MSN G2-202

Need Help? 

If you are experiencing any issues, please contact HR Operations via email: hroperations@worldbank.org  or phone 202-473-2222 or 5220+32222.

Revision 25 Apr 2023

Staff Member Contact

World Bank Group UPI*

<< Please type UPI here

First Name*

Middle Name

Last Name*

Name (Last Name, First Name, Middle Name)

Country*

Address*

City*

State / Province*

Postal / Zip Code*

Address, City, State / Province, Postal / Zip Code, Country

Country Telephone Code*

Contact Number*

Phone Number*

E-Mail Address*

Reimbursement Details

List person(s) for whom reimbursement is requested

First Name*

Middle Name

Last Name*

Relationshp*

Date of Birth

( mm/dd/yyyy )*

Travel Itinerary and Costs

Origin Country*

Origin City*

Origin State / Province*

Date of Departure

( mm/dd/yyyy )*

Destination Country*

Destination City*

Destination State / Province*

Date of Arrival

( mm/dd/yyyy )*

Type of carrier or number of miles if by car

Total amount due to you in USD*

Deposit Payment To

 

Bank Name*

Account Number*

Bank Routing Number*

Indicate your SWIFT, ABA, Routing, BLZ, ABI, CAB or sorting code, etc. as required by your bank for direct deposit.

Please provide the copy of your most recent bank statement or a voided check for verification before the funds disbursement

Certification

I certify that the above request is true and reflect the total expenses incurred by me in accordance with the policy for reimbursement of appointment or resettlement expenses. I further certify that I paid for my own arrangement and have not received any reimbursement in connection with these expenses and that I will not request reimbursement of these expenses from any other source.

Staff Member's Signature

Date

After filling this document, you must sign and date it before returning this document to the World Bank Group. Please ensure ALL information in the submission form is complete and accurate before printing the form. This will generate your form(s) as a PDF file. Review the file for accuracy and completeness. If there is an error, please start a new form.