Exhibit A - Summary Statement of Disbursements

A costs applicant should refer to the Commission’s Guidelines for the Assessment of Costs, as set out in Telecom Regulatory Policy CRTC 2010-963 in completing this form.

General Information

Office Expenses
Type Of Disbursement Total Costs Including GST/PST/HST Receipt (where applicable, indicate page reference)
Office Expenses
In-house photocopies (rate of $0.15/copy)
Other photocopies, printing and binding
Postage/Courier
Transcripts
Subtotal
Air Travel
Subtotal
Inter-city train or bus travel
Subtotal
Inter-city car travel (rate of $0.35/km) in addition to the departure and arrival points, please indicate the total number of kilometres travelled
Subtotal
Intra-city car travel (rate of $0.35/km) in addition to the departure and arrival points, please indicate the total number of kilometres travelled
Subtotal
Parking
Subtotal
Intra-city taxi/bus/train
Subtotal
Hotel Accommodation
Subtotal
Private Accommodation (rate of $20/day)
Subtotal
Other Disbursements
Subtotal
Meals taken in connection with a hearing or meeting which took place at a distance of 50 km or less from regular place of work
Meals Number of Breakfasts
($10 allowance)		 Number of Lunches
($12 allowance)		 Number of Dinners
($26 allowance)		 Total Meal Claim
Subtotal
Meals taken in connection with a hearing or meeting which took place at a distance of more than 50 km from regular place of work
Meals Number of days ($48/day) Total Meal Claim
Subtotal

Less Tax Rebate If Applicable

$
$
$
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