THE ACTION GROUP – BIKE MILEAGE (Motorcycle/Bicycle)CLAIM FORM

Deadline- to be with line manager by 1st of the month and payroll by 3rd of the month

SUMMARY / STAFF INFORMATION
Description / Coding / Miles / Staff Name / Staff ID number
Housing & Community Services (HACSS) / 101 / Month of Claim / Date
102
103 / Home Postcode / Bicycle or Motorcycle?
Group Living / 108
Housing & Community Services (HACSS) / 109 / DECLARATION–
I have read the Conditions of Service and I can confirm that;
- All journeys were necessary to the conduct of my job.
-None of the journeys claimed are equivalent to my usual journey to and from my place of work at the start and end of the day.
Applicable to motorcycle claims -
-I have insurance cover for business use.
110
111
West Lothian / 112
116
Falkirk / 117
Children & Adults Transitions Service (CAATS) / 201
202
203
East Lothian Leisure Scheme / 210
Better Breaks -Falkirk / 230 / Signature – this must be handwritten
Summer Playscheme CEC / 250
Advice Services / 402
Everyone Benefits / 403
SLAB Stream 3 / 404 / AUTHORISATION- To avoid any delays in payment please ensure that the claim is for one month only and the employee has signed the declaration before passing to payroll.
BEMAS / 405
FELF / 406
CEC / 408 / LINE MANAGER
Housing Services / 440 / Print Name
Real Jobs Edinburgh Consortium / 501
FSF Falkirk / 507 / Signature
Real Jobs Tryst Cafe / 508
Real Jobs SDS / 510 / Date
Caravan / 701
Policy & Development / 703
Finance/Admin/Human Resources / 801 / DEVELOPMENT MANAGER – authorisation is required for payments over £250.00
Training / 802 / Print Name
Have Your Say/Unallocated / 999
Signature
TOTAL / Date

Bike Mileage Expenses Claim Form – Journey Details

Date of the journey / Postcode at the start of the journey / Postcode at the end of the journey / Reason for the journey / Bicycle or Motorcycle? enter B or M / Ref* / Team/
Project / Miles
TOTAL MILES

*Under reference please enter 0 for travel to and between clients. Enter 1 if the travel is with a client and also enter the clients cost centre in team/project. Enter 2 for commuting journeys i.e. from your home address to your first client or from your last client to your home address. Enter 3 for any other journey. Please note that all journeys MUST contain a reference number.

CYCLISTS AND MOTORCYLISTS SHOULD NOTE THAT THERE IS A GREATER POTENTIAL FOR ACCIDENTS IN CONDITIONS OF POOR WEATHER AND/OR DARKNESS

CONDITIONS FOR PAYMENT – BICYCLE USE

Rates / Per Mile
Bicycle / 16p
Motorcycle / 24p

Please note that bicycle mileage claims will not be paid when;

-Public transport would have been appropriate.

-Walking would have been appropriate.

-The individual journey exceeds 10 miles there and back.

-The total journey in any one day exceeds 20 miles.

H:\infosharing\Finance\PAYROLL FORMS\TRAVEL AND MILEAGE\NEW - Mileage & Travel claim forms\Bike Mileage claim form.docx