Study Leave Expenses Claim Form

STUDY LEAVE EXPENSES CLAIM FORM

• Please complete this form in BLOCK CAPITALS and within 3 months of the end of the training event.

• A claim form should only be completed if personal reimbursement is required.

• Please return with original receipts to:

/ APPLICATION ID NO:
Study Leave Claims
NHS EDUCATION FOR SCOTLAND
2 Central Quay
89 Hydepark Street
Glasgow
G3 8BW
PLEASE READ THE NOTES OVERLEAF BEFORE COMPLETING THE FORM
FULL NAME:
ADDRESS:
POSTCODE:
GMC/GDC No:(Essential for payment reference number)
Title of Training Event:
Date of Start of Study Leave:
Dates and Time of Leaving Home:
Date and Time of Return:
CLAIM / APPROVED (for office use only)
REGISTRATION FEE / £ / £
TRAVEL(Air, Rail, Taxi, Parking etc.) / £ / £
MILEAGE: miles @ 24p/mile / £ 0.00 / £
TOTAL TRAVEL (if applicable) / £ 0.00 / £
ACCOMMODATION / £ / £
SUBSISTENCE / £ / £
TOTAL CLAIM / £ 0.00 / £
SIGNATURE: / DATE:
If you would like to receive Study Leave correspondence by e-mail, please supply address clearly below:
FOR OFFICE USE ONLY
CLAIM AUTHORISED: / DATE:
CLAIM NUMBER:

NHS EDUCATION FOR SCOTLAND

Allowances and Expense Claims – Current Rates, last updated 1 July 2008

1.Please remember that all expense claims MUST be accompanied by ORIGINAL tickets, receipts etc. No payment will be made until such evidence is received by your local Deanery office.

1. Where available, a copy of your “Certificate of Attendance” should be submitted with this Claim Form.

1. Each expense claim must show the date and time that the claimant left home and returned.

• TRAVEL

-Please note that thecheapest form of transport should be used at all times. No First Class Travel will be reimbursed unless it can be proved to be cheaper than Standard Class Travel. If not cheaper, the Standard Class Fare for the equivalent journey will be reimbursed.

-All claims for reimbursement of train, plane, taxi etc. fares, if applicable, MUST be accompanied by original receipts. Boarding Passes are not classed as a receipt.

-Mileage Allowance: 24p per mile (Public Transport Rate)

-Additional Passenger: 5p per mile per passenger (this must be entered separately, and the name of the passenger clearly stated).

• ACCOMMODATION

-COMMERCIAL ACCOMMODATION: Actual receipted costs of bed and breakfast up to a maximum of £75.00 per night.

-NON COMMERCIAL ACCOMMODATION: Reimbursement of actual costs incurred up to £25.00. All receipts for meals and accommodation up to the amount claimed must be enclosed.

• MEALS

-Actual receipted costs up to the following maximum limits:

Absence of 5 - 10 hours (must include 12.00 - 2.00pm)a maximum of £5.00.

Absence exceeding 10 hours (must end after 7.00pm)a maximum of £15.00

Full 24 Hour Perioda maximum of £20.00

-There will be no reimbursement for alcoholic drinks included in receipts.

1. CANCELLED EVENTS

Should the event that you are claiming for be subsequently cancelled then it is your responsibility to inform the Programme Director and the Deanery so that your study leave records can be updated. Any refunds from course providers should be made out to "NHS Education for Scotland", where possible, however if you are personally refunded then please contact your Deanery to arrange repayment as soon as possible.

PLEASE NOTE THAT EXPENSES MUST BE CLAIMED WITHIN 3 MONTHS

OF THE END DATE OF THE APPROVED STUDY LEAVE EVENT.

Version 1.4 04/07/2013