THE ACTION GROUP MILEAGE EXPENSES CLAIM FORM – Deadline must be with your line manager by the 1st of the month and with payroll by the 3rd of the month – SUMMARY STAFF INFORMATION Staff ID Description Coding Staff Name number Month of Housing & Community Services (HACSS) 101 Date Claim 102 Car 103 Home Postcode Registration Group Living 108 Housing & Community Services (HACSS) 109 DECLARATION – I have read the Conditions of Service and I can confirm that; 110 All journeys were necessary to the conduct of my job. 111 West Lothian 112 All car journeys claimed for could not reasonably be undertaken by public transport. 116 None of the journeys claimed are equivalent to my usual journey to and from my Falkirk 117 place of work at the start and end of the day. Children & Adults Transitions Service (CAATS) 201 I have insurance cover for business use. 202 I am an authorised driver for The Action 203 East Lothian Leisure Scheme 210 this must be handwritten Signed – Better Breaks -Falkirk 230 Summer Playscheme CEC 250 AUTHORISATION To any delays in payment please ensure that the claim is for – Advice Services 402 one month only and the employee has signed the declaration before passing to payroll. Everyone Benefits 403 LINE MANAGER SLAB Stream 3 404 Is the employee an authorised driver? BEMAS 405 – check cascade prior to authorising this claim FELF 406 CEC 408 Print Name Housing Services 440 Real Jobs Edinburgh Consortium 501 Signature FSF Falkirk 507 Real Jobs Tryst Cafe 508 Date Real Jobs SDS 510 Caravan 701 Policy & Development DEVELOPMENT MANAGER authorisation is required for payments over £250.00 703 – Finance/Admin/Human Resources 801 Print Name Training 802 Have Your Say/Unallocated 999 Signature TOTAL Date
THE ACTION GROUP – MILEAGE EXPENSES CLAIM FORM Deadline – must be with your line manager by the 1st of the month and with payroll by the 3rd of the month SUMMARY STAFF INFORMATION Description Coding Staff Name Staff ID number Housing & Community Services (HACSS) 101 Month of Claim Date 102 103 Car Registration Home Postcode 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. All car journeys claimed for could not reasonably be undertaken by public transport. 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. I have insurance cover for business use. I am an authorised driver for The Action 110 111 West Lothian 112 116 Falkirk 117 Children & Adults Transitions Service (CAATS) 201 202 203 East Lothian Leisure Scheme 210 Signed – this must be handwritten Better Breaks -Falkirk 230 Summer Playscheme CEC 250 AUTHORISATION – To 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. Advice Services 402 Everyone Benefits 403 SLAB Stream 3 404 LINE MANAGER BEMAS 405 Is the employee an authorised driver? – check cascade prior to authorising this claim FELF 406 CEC 408 Print Name Housing Services 440 Real Jobs Edinburgh Consortium 501 Signature FSF Falkirk 507 Real Jobs Tryst Cafe 508 Date Real Jobs SDS 510 Caravan 701 Policy & Development 703 DEVELOPMENT MANAGER – authorisation is required for payments over £250.00 Finance/Admin/Human Resources 801 Print Name Training 802 Have Your Say/Unallocated 999 Signature TOTAL Date
mileage-claim-form.docx