Expenses Details of Journey – (start-> to -> finish) Mode of transport: __ £ Public Transport (Receipts must be attached) Total Number of Miles: _@ 45p per mile £ Private Transport (Mileage will be calculated at shortest route) Name(s) of passenger(s): ____ Passengers £ Total miles travelled with passenger _ (Reimbursed at 5p per mile per passenger) (Passengers must be travelling to the same event & also entitled to reimbursement of travel expenses) Accommodation Expenditure £ Subsistence Meal Expenditure £ Other Expenses £ Please specify:- TOTAL AMOUNT OF CLAIM £ DETAILS OF CLAIM (ALL CLAIMS MUST BE ACCOMPANIED BY RECEIPTS) Please read the guidance notes you obtained along with this claim form very carefully. Where there is no receipt a written explanation must be attached and payment will at the discretion of HEE West. HEE - South West reserves the right to reimburse the cheapest option wherever relevant. EVENT/ACTIVITY LOCATION DATE(S) From: To: Claimant Declaration: I declare that the expenses claimed hereunder were necessarily incurred by me in attending the above event and are in accordance with the conditions governing the payment of travelling expenses attached. I understand that any fees are paid gross and that I am responsible, where appropriate, for declaring this income for tax purposes. Signed: Date: Please send the completed form to :- Health Education England - South West Deanery House Vantage Office Park Old Gloucester Road Hambrook Bristol, BS16 1GW Authorised By Name : Contact Number: Signed : Date:
Expenses Details of Journey – (start-> to -> finish) Public Transport Mode of transport: __ (Receipts must be attached) £ Private Transport Total Number of Miles: _@ 45p per mile (Mileage will be calculated at shortest route) £ Passengers (Reimbursed at 5p per mile per passenger) Name(s) of passenger(s): ____ Total miles travelled with passenger _ (Passengers must be travelling to the same event & also entitled to reimbursement of travel expenses) £ Subsistence Accommodation Expenditure £ Meal Expenditure £ Other Expenses Please specify:- £ TOTAL AMOUNT OF CLAIM £ DETAILS OF CLAIM (ALL CLAIMS MUST BE ACCOMPANIED BY RECEIPTS) Please read the guidance notes you obtained along with this claim form very carefully. Where there is no receipt a written explanation must be attached and payment will at the discretion of HEE West. HEE - South West reserves the right to reimburse the cheapest option wherever relevant. EVENT/ACTIVITY LOCATION DATE(S) From: To: Claimant Declaration: I declare that the expenses claimed hereunder were necessarily incurred by me in attending the above event and are in accordance with the conditions governing the payment of travelling expenses attached. I understand that any fees are paid gross and that I am responsible, where appropriate, for declaring this income for tax purposes. Signed: Date: Please send the completed form to :- Health Education England - South West Deanery House Vantage Office Park Old Gloucester Road Hambrook Bristol, BS16 1GW Authorised By Name : Contact Number: Signed : Date:
PD-HEE-Expenses-Invoice-Severn.docx