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[null,null,"RESERÄKNING"]
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[]
[]
["PERSONALIA",null,"UTBETALNINGSANVISNING"]
["Namn",null,"Bankkonto: "]
["Adress",null,"Clearing-nr_______ ",null,"Konto-nr:_______ "]
["Postnr/ort"]
["Person-nr"]
[]
["RESA",null,null,"Datum","Tid"]
["Från",null,"Avresa"]
["Till",null,"Återkomst"]
[]
["UPPDRAGETS ART  "]
[]
[]
[null,null,"Antal tim","Belopp ","Summa"]
["ARVODE"]
[]
[null,null,"Antal tim","Belopp ","Summa"]
["Ersättning för uppdrag utförda utanför ordinarie arbetstid"]
[]
["BILERSÄTTNING",null,"Antal km","Km-ers.","Summa"]
[{"$nulls":3},"2:50"]
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["ÖVRIGA KOSTNADER; resor, logi m.m. (Kvitton måste bifogas)",{"$nulls":3},"Summa"]
[]
[]
["ERSÄTTNING FÖR FÖRLORAD ARBETSFÖRTJÄNST"]
["Enligt bifogad lönespec."]
[]
["Ort",null,"Datum  "]
[]
["Underskrift ________________________________________________________"]