Spreadsheet: 2c6297cb-cf87-49ac-940b-2ac5ec38c58e
Sheet: Sheet1

Unnamed: 0 | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | When completed, please print, sign and pass to an Authorised Signatory for approval.  When authorised, please send with original receipts to Accounts Payable for processing. | 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 | FOREIGN BANK EXPENSE PAYMENT | 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 | Unnamed: 42 | Unnamed: 43 | Unnamed: 44 | Unnamed: 45
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Surname |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date (ddmmyy) |  | No of Claims for this Date
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Document No: |  |  |  |  |  | EXPFX
Payee Type (please mark X where appropriate) |  |  |  |  |  |  |  |  |  |  |  |  | Employee |  |  |  |  |  |  |  |  | Student |  |  |  |  |  |  | Other |  |  |  |  |  |  |  |  | Date:
Payee Name |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | No:
Address |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Please enter the number relating to your role, i.e. Payroll No. (if Employee) UPI No (if student), leave blank for Central Finance use if external to UCL.
Town/City |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Post/Zip Code:
Country
Remittance Email Address
Total Amount in Currency Stated |  | 0 |  |  |  |  |  |  |  |  |  |  |  |  | Currency Code |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | If not sure of currency code, please go to link: |  |  |  |  |  |  |  |  |  |  |  |  | www.xe.com/currency
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Please note, only one currency can be claimed on each form.
Bank Name |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | IBAN No.
Bank Address |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Please note: IBAN numbers are compulsory for EC payments.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Swift Code/BIC
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Please note: Swift/BIC codes are compulsory for ALL payments.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Bank Clearing Code/ABA
Bank Acc No.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Optional
Account Code Analysis - Please amalgamate items being charged to the same account and analysis code into one distribution line.  If there are more than 5 lines, please enter on a spreadsheet and attach to this form.
Description (this will appear on the departmental transaction report) |  |  |  |  |  |  |  |  |  | GL Code |  |  |  |  |  |  |  |  | Research Grant or Project code |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME]
 |  |  |  |  |  |  |  |  |  | Account |  |  |  | Analysis |  |  | Opt |  | Grant |  |  |  | Task |  |  |  | Expend. [NAME] Analysis |  |  |  | Please enter amount (Net amount if GBP payment) |  |  |  |  |  |  |  |  |  |  | Currency Code, i.e. EUR | VAT code | [NAME] | Gross Amount
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | D- |  |  |  | 6 |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  |  | O | 0.00 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | D- |  |  |  | 6 |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  |  | O | 0.00 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | D- |  |  |  | 6 |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  |  | O | 0.00 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | D- |  |  |  | 6 |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  |  | O | 0.00 | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | D- |  |  |  | 6 |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  |  | O | 0.00 | 0
VAT Code Descriptions:
0 | Zero-rated goods or services |  |  |  |  |  |  |  |  |  |  |  |  |  | Total Amount excluding VAT |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
S | Standard 20% rated goods or services |  |  |  |  |  |  |  |  |  |  |  |  |  | Total VAT Amount |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
N | No VAT identified |  |  |  |  |  |  |  |  |  |  |  |  |  | Total Amount including VAT |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
E | VAT Exempt goods or serv ices
C | Purchases from EU countries.
W | Purchases from Rest of the World
Analysis of Expenditure (Please attach supporting receipts, number and cross reference to the table below)  If you have more than 6 receipts, please enter on a spreadsheet and attach to this form.
Ref | Date of Exp. (dd.mm.yy) | Purpose of Expenditure |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Amount
1 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
2 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
3 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
4 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
5 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
6 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
Car Mileage |  | c.c: |  |  |  |  |  |  |  |  |  |  |  | [NAME] |  |  |  |  |  |  |  |  |  |  |  |  | At: |  |  |  |  |  |  |  |  |  | p per mile |  |  |  |  |  |  | 0
 |  | Journey | From: |  |  |  |  |  |  |  |  |  |  |  |  |  | To: |  |  |  |  |  |  |  |  |  | Total Amount including VAT |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
I confirm that the above expenditure has been incurred as a result of UCL activities only and that the bank details given are correct and can be used by UCL.
Claimant Signature: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date:
Authorised Signatory Name:
Signature: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date: