EXPENSES CLAIM FORM GP SPECIALTY TRAINEES – CLAIMS IN RESPECT OF EXPENSES FOR EDUCATIONAL PURPOSES NAME: POST: ……………….…………………………………………. ……………………………………………………. TRAINER/CLINICAL SUPERVISOR NAME:- ………………………………………………………………… TRAINING PROGRAMME:: ……………………………………………………. …………………………………… Nature of Business (eg event Date Course fee No of miles Passenger Other costs e.g. Authorised signatory ** – attended) / Course Name Claimed names rail fares (attach receipts) I declare that: a) The expenses and allowances claimed are in accordance with the GP Registrar Directions (2003) with 2007 Amendments and NW Deanery policies and are in connection with official visits to the places indicated on the date(s) shown. b) Where a claim for mileage is made: (i) Travel by a Public Service vehicle was not appropriate (ii) The vehicle has a current Road Fund License and is in a road-worthy condition complying with Road Traffic Acts. (iii) An insurance policy will continue to be maintained while the car is used by me and will cover the use of the car on official business. c) No other claim has been or will be made by me on any public body for expenses or allowances in connection with the business stated. Signed (Claimant) Date: …………………………………………………………………………………………… …………………… ** An authorised signatory must confirm attendance at the individual course. This may be the course or administrator
EXPENSES CLAIM FORM – GP SPECIALTY TRAINEES CLAIMS IN RESPECT OF EXPENSES FOR EDUCATIONAL PURPOSES NAME: ……………….…………………………………………. POST: ……………………………………………………. TRAINER/CLINICAL SUPERVISOR NAME:- ………………………………………………………………… TRAINING PROGRAMME:: ……………………………………………………. …………………………………… Nature of Business (eg event attended) / Course Name Date Course fee No of miles Claimed Passenger names Other costs – e.g. rail fares (attach receipts) Authorised signatory ** I declare that: a) The expenses and allowances claimed are in accordance with the GP Registrar Directions (2003) with 2007 Amendments and NW Deanery policies and are in connection with official visits to the places indicated on the date(s) shown. b) Where a claim for mileage is made: (i) Travel by a Public Service vehicle was not appropriate (ii) The vehicle has a current Road Fund License and is in a road-worthy condition complying with Road Traffic Acts. (iii) An insurance policy will continue to be maintained while the car is used by me and will cover the use of the car on official business. c) No other claim has been or will be made by me on any public body for expenses or allowances in connection with the business stated. Signed (Claimant) …………………………………………………………………………………………… Date: …………………… ** An authorised signatory must confirm attendance at the individual course. This may be the course or administrator