Supporting Documentation/ORIGINAL Receipts MUST Be Attached

Date: … … … … … … … … …

Date… … … … …

Name of Payee: … … … … … … … … … … … | … … … Cust A/C No:… … … … …

(Surname in block capitals Initials) (Finance to complete)

Address to which
Cheque is to be sent
(2) / (1)
Date / Time Absent / Detail and reason for journey
Destination from and to / Car Mileage / Travel (excluding car mileage) / Other Expenses
From / To

Supporting documentation/ORIGINAL receipts MUST be attached

/ £ / p / £ / p
Totals / 1
To be completed by claimant / Mileage Costs / (3) / £ / p / 2
I certify that the expenditure detailed above was actually and properly incurred by me for the purposes stated. / 3
… … Miles x … … p
… … Miles x … … p

Signed … … … … … … … …

/ Total of Claim

To be completed by Authorised Signatory

I authorise payment of this claim and / Reference/
Order No.
Confirm it complies with University / TC / £ / P
Regulations
/

Allocation Code

Signed … … … … … … …

School/

Below this line, Finance Dept. use only

Other Grp. … … … … … … … …

University

(Print)

Reference

Date … … … … … … …

Passed for Payment

Incomplete forms will be returnedGuidance Notes - overleafNote:

TRAVEL AND SUBSISTENCE RATES FOR
MEMBERS OF EXPERT COMMITTEES

Please read this explanatory note before making arrangements to attend meetings.

To meet the requirements of the NHS Executive, all tickets Must be attached. They must be originals, Not copies and they should be full tickets, not sales vouchers. This is an inland revenue/audit requirement. It is not acceptable to state receipts are lost/not available. Note that incomplete claims will not be processed for reimbursement. When using the underground and rail please show tickets to guard and retain, do not use automatic barrier as it will keep used tickets and this will delay payment of your claim. Thank you for your co-operation.

The review has been undertaken. The following changes were agreed with effect from 1st May 1995 and revised from 1st October 2008.

i) Car Mileage allowances have been set at a flat rate of 40p a mile for all necessary business, and a passenger supplement of 4p per mile for one and 2p per additional passenger per mile.

ii) Motorcycle journeys on your own motorcycle are reimbursed at the single rate of 24p per mile.

iii) Travel allowances for public transport – you may claim all reasonable receipted expenses for rail and air travel at 1st class rail and economy air. Taxis may be used for local journeys and must be receipted.

iv) Overseas subsistence rates are set separately for each country and expressed in the currency of the country.

v) Overnight accommodation allowance is up to £85.00 (£115 in London) per night of receipted costs. Plus an overnight subsistence flat rate of £22.50 for meals and residual expenses for a full 24 hours.

vi) Alternatively if you stay anywhere else but a hotel (e.g. a private household) a flat rate allowance of £27.50 per night is applicable.

vii) Day Subsistence for hours spent away from home is payable as follows

Less than 5 hoursNil

5 – 10 hours£5.00 (e.g. one receipted train meal)

10 – 12 hours£10.00 (e.g. two receipted train meals)

12 – 24 hours£10.00 plus actual cost of a third meal up to £13.50

NB:A separate claim form is required from each individual and receipts for all expenditure should be attached to the claim form.

With reference to receipts, all tickets should be attached and should be originals (i.e. NOT copies) and they also should be full tickets (i.e. NOT sales vouchers).

Please submit your claim promptly, preferably as soon as you return, so as to ensure quick reimbursement.

Please return completed form in attached envelope, to:

Miss Olivia Pearl

NETSCC, SDO Programme

Alpha House, Enterprise Road

Southampton Science Park, Chilworth

Southampton, SO16 7NS

Lat updated – October 2008

J:\Prioritisation\Expenses\Current\Travel claim form oct 2008.doc