The fee for this examination will be taxable under HMRC Regulations; all expenses will be reimbursed.
Payment will be made by direct credit to your bank or building society account.
This claim should be completed in BLOCK CAPITALS and forwarded to the Faculty as soon as possible after the examinations are completed.
Claimant/Examiner
Title:(please tick one): / Mr / Mrs / Ms / Miss / Professor / Dr
Surname / Forenames
Pay Reference Number: / (see previous pay advice)
Date of Birth: / (dd/MM/yyyy)
IMPORTANT: Your Date of Birth is a Statutory Requirement and will result in delay in payment if not completed.
National Insurance number: / e.g. XY123456Z
Signature of Claimant / Date
If you have made a previous claim, and there are no changes to your personal details as set out in this section, please just complete the section above.
The following details only need to be completed if this is the first claim you have submitted or if there are any changes to your personal details
Home address: / Bank/Building Society
Branch:
Sort code: / X / X
Account number
For non-UK account, Currency:
Postcode: / IBAN number:
SWIFT number:
Email address:
Claim for Candidate:
/ /
Faculty:
/
/ /
Division
/
Details of travel and route
Public transport* fares or mileage for private car / £ / p
Examiner’s fee
Travelling expenses [1]
Subsistence[2]
Incidental Expenses e.g. telephone, postage etc [3], [4]
*If travelling by public transport, only standard fares will be reimbursed / Total amount claimed

Updated May 2012 by eat

Payment authorised on behalf of / For use in the Finance Department
Head of Faculty / Cost centre / £ / p
Faculty
Faculty Authorised signature
Date
Total


Notes on completing the claim form

Updated May 2012 by eat

[1] External Examiners may claim reasonable travelling costs within the University rate, which in general require standard class period return rail tickets to be used, unless day returns or “savers” are available at a lower cost. Payment for air travel may be approved providing the total cost does not exceed that of rail travel plus subsistence costs. The dates of travel, departure point and route of journey must be shown. All original receipts must be provided. Payment of travel by car, motorcycles or bicycles will be paid at the following rates, per round trip.

40 p per mile for the first 50 miles

23 p per mile thereafter

24 p per mile for Motorcycles

20 p per mile for Bicycles

If necessary, please provide additional information on a separate sheet.

[2] Subsistence expenses will be reimbursed providing details are shown and original receipts provided. Expenditure of personal nature (alcohol from “mini-bars”, newspapers, laundry, videos) should not be included in claims for reimbursement.

[3] Incidental expenses – please give details if necessary on a separate sheet.

[4] Please note: the University has been instructed by the Inland Revenue that all claims for travel, subsistence and related costs must be supported by original receipts, till rolls or equivalent, except for the few cases where receipts are retained (for example, certain parking barriers). Receipts are given on trains, in take-away restaurants etc. on request, or till rolls are given.