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[]
[]
[]
[]
[]
[" APPLICATION FOR REIMBURSEMENT FORM"]
["Please email completed forms to: ",null,null,"claims@coallsl.com.au"]
[]
[]
["Employer Details"]
["Employer ID:"]
["Company Name:"]
["Contact Name:"]
["Contact No:"]
[]
["Authorised Officer"]
["Name:"]
["Position held:"]
["Contact No:",null,null,null,false]
[null,null,"I certify that the details shown below are correct and that the PAYMENT HAS BEEN MADE to each of the “Eligible Employees” listed."]
[]
[]
["Application Number ","LSL Number","Surname","Given Name(s)","Date of Birth (dd/mm/yyyy) ","Number of Hours              (5 decimal places) ","Date Leave Commenced (dd/mm/yyyy) ","Hourly Award/ Negotiated rate                   (2 decimal places)","Hourly Bonus Paid (must be paid at least monthly)               (2 decimal places)","Hourly Other Over Award  Payments        (2 decimal places) ","Total Hourly Rate ","Total Claimed ","Date LSL Payment Made to Employee (dd/mm/yyyy)"]
[null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(H26:J26)","v":0},{"$f":"F26*K26","v":0}]
[null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(H27:J27)","v":0},{"$f":"F27*K27","v":0}]
[null,null,null,null,null,null,null,null,null,null,0,0]
[null,null,null,null,null,null,null,null,null,null,0,0]
[null,null,null,null,null,null,null,null,null,null,0,0]
[null,null,null,null,null,null,null,null,null,null,0,0]
[null,null,null,null,null,null,null,null,null,null,0,0]
[null,null,null,null,null,null,null,null,null,null,0,0]
[null,null,null,null,null,null,null,null,null,null,0,0]
[null,null,null,null,null,null,null,null,null,null,0,0]
[null,null,null,null,null,null,null,null,null,null,0,0]
[null,null,null,null,null,null,null,null,null,null,0,0]
[null,null,null,null,null,null,null,null,null,null,0,0]
[null,null,null,null,null,null,null,null,null,null,0,0]
[null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(H40:J40)","v":0},{"$f":"F40*K40","v":0}]
[null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(H41:J41)","v":0},{"$f":"F41*K41","v":0}]
[null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(H42:J42)","v":0},{"$f":"F42*K42","v":0}]
[null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(H43:J43)","v":0},{"$f":"F43*K43","v":0}]
[null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(H44:J44)","v":0},{"$f":"F44*K44","v":0}]
[null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(H45:J45)","v":0},{"$f":"F45*K45","v":0}]
[null,null,null,null,null,null,null,null,null,"TOTAL CLAIMED",null,{"$f":"SUM(L26:L45)","v":0}]
[]
["Please Note: ","All details requested above need to be provided to ensure that the application for reimbursement can be processed."]
[]
["Privacy Statement "]
["Personal information collected by Coal LSL is protected by the Privacy Act 1988. Our Privacy Policy is available at www.coallsl.com.au and sets out the primary purposes for which Coal LSL collects, uses and discloses your personal information. Coal LSL will not use or disclose your personal information for other purposes unless you consent or it is permitted to do so by the Privacy Act 1988."]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,"TRANS 35.2"]