REQUEST FOR SOUTHERN DHB INVOICE 
                                 REQUEST FOR SOUTHERN DHB INVOICE 
                                                                                 DATE OF              [ _ _/_ _ /20_ _ ]
                                                                                 REQUEST:
            RESEARCH TEAM CONTACT DETAILS:
            RESEARCH TEAM CONTACT DETAILS:
            Name of Principal Investigator:
            Name of Research Team  contact person: 
            Phone number of Research Team contact 
            person:
             
            PROJECT DETAILS:
            PROJECT DETAILS:
            Research project account name:
            Research project account number:           CF 
            INVOICE TO BE SENT TO:
            INVOICE TO BE SENT TO:
            Organisation name:
            Attention to: 
            Address: 
            Payment reference (from 
            Sponsor/CRO): 
            GST & OVERHEADS
            GST & OVERHEADS
            Is this a GST claimable invoice?           Yes           No
            SIGNATURE OF AUTHORISER
            SIGNATURE OF AUTHORISER
            PARTICULARS
            PARTICULARS
              Quantity                           Description                            Unit Price       Line Total
              Quantity                           Description                            Unit Price       Line Total
                                                                                             Subtotal
                                                                                               GST (if
                                                                                            claimable)
                                                                                                TOTAL
            SPECIAL INSTRUCTION / COMMENTS
            SPECIAL INSTRUCTION / COMMENTS
            PLEASE SEND THIS FORM TO:    Southern DHB Accounts & Finances 
            
           HRS_ “REQUEST FOR Souther DHB INVOICE” FORM  V3
           ISSUED ON: Feb 2011;  REVIEWED ON:  Oct 2013, Nov 2017
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                                 Health Research Office, 1st Floor, Dunedin Hospital, c/- Dean’s Office, DSM Mailbox
                                                hrs@otago.ac.nz; www.otago.ac.nz/hrs