GC47(Page 1)

School Resettlement Grant

Please complete details of amounts claimed below and sign the declaration on the reverse of this form. Part 2 of this form should also be completed and both forms should then be sent to the address shown at the top of page 4.

Name
Position (including subject area) / Payroll reference
National Insurance Number
School / Date commenced
Place of work
Work telephone number
Former home address / New home address
Postcode / Postcode
Telephone Number
Email address

REMOVAL & STORAGE EXPENSESOTHER INITIAL HOUSING COSTS

TRAVEL COSTSINCIDENTAL EXPENSES

TEMPORARY LIVING COSTS

Claims must be accompanied by the original receipted VAT invoice(s)

Details of Claim and details of costs
Please explain fully what the claim is for, e.g. Removal costs, help with rental costs, etc / Amount Excl VAT / VAT
£ / p / £ / p
TOTAL

GC47 (page 2)

LEGAL AND ASSOCIATED EXPENSES

Claims must be accompanied by original receipted VAT invoice(s)

Please state whether you are claiming in respect of:

Sale onlyPurchase onlySale and Purchase

Details of Amounts Claimed / Amount Excl VAT / VAT
£ / p / £ / p
TOTAL

DECLARATION

I wish to claim assistance with the costs of moving home which are allowable under the

Essex County CouncilResettlement Grant Scheme and I understand that I must meet the conditions below in order to be eligible.

Please tick relevant box

I therefore declare that: Yes No

I previously lived more than 40 miles from my new place of work and needed to move house to take up the appointment

My permanent move is to a location which is appreciably nearer my place of work both in distance and time (within 25 milesof the new place of work)

I am genuinely relocating to take up my appointment with a Community, Foundation or VoluntaryAidedSchool in Essex and incurring additional expenditure to do so.

My partner or joint purchaser/lessee will not receive a similar allowance from any other employer

I have not made a claim under the Essex County Council Relocation Scheme

I also undertake to remain in the service of a Community, Foundation or Voluntary Aided School in Essex for a minimum period of one year from the date of appointment. I understand that in the event of not complying with this requirement by either voluntarily leaving, or being lawfully dismissed from the service of a Community, Foundation or VoluntaryAidedSchool in Essex I will be expected to repay all of the total grant. I will notify the County Council and my school of anychanges in circumstances, which may affect my eligibility for payments under the schemes.

GC47 (page 3)

I will immediately notify my Schoolof any changes in my circumstances which may affect my eligibility for payments under this scheme.

I also certify that amounts claimed by me have actually been incurred as a result of moving to the above address in order to take up my appointment with Essex County Council.

Signed______

Print name______

Date______

Contact Telephone Number______

Please complete the relevant boxes below

Total of relocation expenses claimed (including this claim)

£ p

Removal expenses

Travel expenses

Temporary living costs

Other initial housing costs

Incidental expenses

Legal expenses

Total claimed so far

BANK ACCOUNT DETAILS

Is this the final claim under the Resettlement Grant Scheme?

YesNo

GC47 (page 4)

Please return this form to:Schools Recruitment Team

EES for Schools

Seax House

Victoria Road South

Chelmsford

CM1 1QH

______

TO BE COMPLETED BY THE CERTIFYING OFFICER

Please bring forward totals from GC47 (Page 1) and enter codes below.

Expenditure Codes£ p VAT

Other / Taxable
Expenses / Non-Taxable
Legal & Assoc. / Taxable
Expenses / Non-Taxable
Total
Claimed

I certify that the above amounts are properly payable in accordance with the Notes of Guidance for the Resettlement Grant Scheme

Authorised Certifying Officer ______Date______

Print Name______Contact No______