5.1 Claim for the reimbursement of costs and remuneration Page: 1784 / No. 13 / 2017 Official Gazette of the Republic of Slovenia Form 1 Claim for the reimbursement of costs and remuneration The undersigned __________________________________________________________, by occupation ____________________________________________________________, residing at _______________________________________________________________, tax identification number ____________________________________________________, bank account number ______________________________________________________, opened with ______________________________________________________________, have cooperated in the performing of monitoring at ________________________________________________________________________, on __________________, from ________ to ________ (time from arriving at the site of the visit to leaving the site of the visit), leaving the place of residence at _______________________________________________ (state place of residence) at ____________________ and returning to place of residence at _____________________. Please acknowledge and pay: 1. SYMBOLIC PAYMENT Number of hours of actual monitoring, increased by two hours Amount of remuneration for each commenced hour Total EUR 2. PAYMENT FOR PREPARING THE FULL OR PARTIAL REPORT ON MONITORING OR THE ANNUAL REPORT Full 102 Partial/Annual Report Total EUR IMPLEMENTATION OF THE DUTIES AND POWERS OF THE NPM IN 2017 NATIONAL PREVENTIVE MECHANISM UNDER THE OPTIONAL PROTOCOL TO THE UN CONVENTION AGAINST TORTURE AND OTHER CRUEL, INHUMAN OR DEGRADING TREATMENT OR PUNISHMENT