RELOCATION EXPENSES ENQUIRY FORM

Eligibility and Entitlement

Name:
NTN number:
Placement address:
Actual date of commencement:
Previous address: / (Proposed) New address:
Miles from Placement / Miles from Placement

I wish to claim:

  1. Assistance towards removal of Personal Effects:Y/N
  2. Assistance towards house purchase Y/N
  3. Assistance towards travel expenses Y/N
  4. Assistance towards storage expenses Y/N
  5. Assistance towards rental expensesY/N

Written receipts (on company headed paper) must be provided for all actual and necessary costs claimed for. These will be checked for validity.

Signed …………………………………(trainee).Dated ……………………..

You are entitled to assistance with relocation up to a maximum aggregated sum of

£…………… (please refer to policy for maximum allowances)

Signed ……………………………Medical HR ManagerDated……………………
APPLICATION FOR ASSISTANCE TOWARDS RELOCATION FOR SPECIALTY TRAINEES IN DEANERY APPROVED TRAINING POSTS
Name of applicant:
Present Appointment:
Length of Appointment:
Post/Department
Grade & Salary
Date of commencement
Present Address
Previous Address
Date of Removal

Summary of Total Costs incurred

SUMMARY
Items / £ / P

1

/ Permanent Accommodation

2

/ Temporary Accommodation

3

/ Temporary Storage

4

/ Removal of furniture and effects

5

/ Travel costs
TOTAL CLAIMED

Details of Actual Expenses Incurred

Item / £ / P
1 / Permanent Accommodation

Legal expenses in connection with new accommodation purchase

Solicitors fees
Stamp duty
Land registration fees
Survey fees
Other
Total
Evidence provided

Legal expenses in connection with the sale of the employees house in which he was living immediately before the new appointment:

Legal costs of sale, including legal expenses in redemption of mortgage
House agent’s or auctioneer’s fees
Total
Evidence provided
2 / Temporary Accommodation

The cost of tenancy agreement (if any) where rented accommodation is taken up.

Cost of agreement
House agent’s fees
Total
Evidence provided
3 / Temporary Storage of furniture and effects
Storage and insurance charge (if any)
Total
Evidence provided
4 / Removal of furniture and effects
Removal of household furniture and effects (Lowest tender)
Insurance
Total
Evidence provided
5 / Excess daily travelling expenses
To be claimed on grey travel expenses claim form
Total miles to be claimed (home to base return)
………….. per month
Evidence provided
6 / Other Arrangements (Please Detail)
Total
Evidence provided

I HAVE READ AND FULLY UNDERSTOOD THE HEALTH EDUCATION EAST OF ENGLAND POLICY FOR THE REIMBURSEMENT OF REMOVAL AND ROTATIONAL TRAVEL EXPENSES FOR DOCTORS IN TRAINING AND:

  1. Understand and agree that I have been granted assistance with relocation in accordance with the conditions of this policy.
  1. Confirm that the expenses that I am claiming are the only expenses I will be receiving on changing my residence.
  1. Confirm that the information given on this form is accurate to the best of my knowledge.

Signed:………………………………………………………………………………………

Name: ………………………………………………………………………………………

Date: ………………………………………………………………………………………