Spreadsheet: 036b6c72-a503-41b6-a183-22d3c55113e4
Sheet: Sheet1

Unnamed: 0 | NB: All boxes indicated by * on this page must be completed or payment will be delayed. | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Unnamed: 16 | Unnamed: 17 | Unnamed: 18 | Unnamed: 19 | Unnamed: 20 | Unnamed: 21 | Unnamed: 22 | Unnamed: 23 | Unnamed: 24 | Unnamed: 25 | Unnamed: 26 | Unnamed: 27 | Unnamed: 28 | Unnamed: 29 | Unnamed: 30 | Unnamed: 31 | Unnamed: 32 | Unnamed: 33 | Unnamed: 34 | Unnamed: 35 | Unnamed: 36 | Unnamed: 37 | Unnamed: 38 | Unnamed: 39 | Unnamed: 40 | Unnamed: 41
 | F | UNIVERSITY OF BRISTOL |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | FEE CLAIM FORM |  |  |  |  |  |  |  |  |  |  | F
 | E | * DEPARTMENT: |  |  |  |  |  |  |  |  |  |  |  |  |  | NI No |  |  |  |  |  |  |  |  |  | NON-CONTRACT STAFF ONLY |  |  |  |  |  |  |  |  |  |  | E
 | E |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | PLEASE PRINT CLEARLY |  |  |  |  |  |  |  |  |  |  | E
 | SECTION 1 |  |  |  |  |  |  | NB: SECTION 2 OVERLEAF MUST BE COMPLETED OR PAYMENT WILL BE DELAYED
 | * CLAIMANT |  |  |  |  |  |  |  |  |  |  |  |  |  |  | * UoB Employees |  |  |  |  |  |  |  |  |  | * Self Employed Individuals
 | (Name, Title & ALL initials) |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Must complete boxes below |  |  |  |  |  |  |  |  |  | Please complete boxes below
 | Home address (Essential for P60 despatch) |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 'Own' Department |  |  |  |  |  |  |  |  |  | Confirm status questionnaire completed
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Y/N |  |  |  |  |  |  |  |  |  |  |  |  | CONTRACT STAFF ARE
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME]: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | P/TIME TEACHERS etc
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Payroll No. |  |  |  |  |  |  |  |  |  | Reference issued by tax department |  |  |  |  |  |  |  |  |  |  |  |  | THEY SHOULD USE THE
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | LANDSCAPE FORM
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date of Birth: |  |  |  |  |  |  |  |  |  | Date of Birth: |  |  |  |  |  |  |  |  |  |  |  |  | Ref: FEE P/T
 | Post Code: |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Gender: |  |  |  |  | M |  | F |  |  | Gender: |  |  |  |  |  | M |  | F
 | Cheques will be sent to the department authorising payment unless one of the boxes below have been ticked
 | Please send cheque to my |  |  |  |  |  |  |  |  | [[NAME] box] |  |  | Own department (see above) >>>> |  |  |  |  |  |  |  |  |  |  |  |  |  | Home Address  >>>>
 |  | If this instruction is different to your last claim please tick this box >
 | Summary of claim: |  |  |  |  |  |  |  |  |  | Dates |  |  | From |  |  |  |  |  | to |  |  |  |  |  | Dep't Ref No:
 | These dates are essential for correct calculation of NI liability
 | Reason for payment of fee:  >>
 | DEBIT GRANT No: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | NB: |  | Please give full details over and attach supporting docs
 | DECLARATION |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | NB: Please give full details over & attach supporting documents |  |  |  |  |  |  |  |  |  |  | Summary
 | I declare that the total claimed has been incurred by me solely in the course of the University's business and does not include costs incurred in travelling between my home and normal place of work. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Fee |  |  | * Hrs worked: |  |  |  |  |  |  |  |  |  |  | £ |  |  |  | p
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | -
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Hourly rate = |  |  |  |  | £
 | I confirm that I have not claimed these expenses before nor will claim them from any other source. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Travel  Expenses
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Give details overleaf
 | I hereby claim reimbursement. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME] claimed from UoB prior to this claim
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | See Note 1 |  |  |  |  |  |  |  |  | *
 | * Signed: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME] now claimed @ 45p |  |  |  |  |  |  |  |  |  | * | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME] now claimed @ 25p |  |  |  |  |  |  |  |  |  | * | 0
 | Dated: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Miles c/fwd |  |  |  |  |  |  | 0 |  |  | *
 | AUTHORISATION |  |  |  |  |  | (Strike out 1st para if box A overleaf ticked) |  |  |  |  |  |  |  |  |  |  |  | Other travel |  |  |  |  |  |  |  |  |  |  | 0
 | I confirm that I have seen the original document indicated at B overleaf and I certify that the attached is a copy of all the pages necessary to identify the claimant and establish his/her eligibility to work. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Accommodation |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Subsistence |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Incidentals |  |  |  |  |  |  |  |  |  |  | 0
 | This claim is correct and in order for payment. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Other Agreed Expenses |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Give details overleaf
 | * Signed: |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Unit Head |  |  | ** | TOTAL CLAIMED |  |  |  |  |  |  |  |  | £ | 0
 | Dated:
 | * Note 1 |  | Persons travelling by car claim |  |  |  |  |  |  | 45 | p per mile for the first 10,000 |  |  |  |  |  |  |  | Note 2 |  |  | The University will normally pay second class return fare.
 |  |  |  |  |  |  |  |  | miles in any 1 year beginning 6th April & | 25 | p per mile thereafter. |  |  |  |  |  |  |  | Note 3 |  |  | Original receipts should be produced. Credit card vouchers
 | Claimants are asked to keep a record of their mileage on behalf of UoB during |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | or statements are not accepted as proof by Inland Revenue.
 | the current tax year starting the previous 6th April & record the cumulative totals |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Note 4 |  |  | Personal expenses (eg Alcoholic drinks) and third party expenses are not allowable
 | above. |  |  | (See Financial Regulations)
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME] |  |  | 1
 |  | FOR  ADMIN USE ONLY |  |  |  |  |  |  |  |  |  |  |  |  | [NAME] |  |  | 2 | Order No:
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME] |  |  | 3 | Other Dep't Ref: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | .
 | * Charge Codes
 | EL1 |  |  |  | EL2 |  |  |  |  |  | EL3 |  |  |  | £ |  |  |  |  |  | p |  | Description
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  |  |  |  |  |  |  |  | Fee
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  |  |  |  |  |  |  |  | Travel and other costs
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 | Expenses |  |  |  | Rates / Calculations |  |  |  |  |  | * TOTAL |  |  |  | 0 |  |  |  |  |  |  |  | For Finance Office use only
 | Allowable |  |  |  | Correct |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Doc Type / Invoice No.
 |  |  |  |  |  |  |  |  |  |  | Must equal total claimed at **
 | Initial when checked |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | F | E | E | G | E | N | 3 |  | FO |  | TC | 13 | 4 | 12
 | NB: All boxes indicated by * on this page must be completed or payment will be delayed. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Page 1