Repayments Form Please submit form to info@theipsa.org.uk 1A MP Name 1B Payer (if different from 1A) 2 Constituency 3 Repayment Amount (£) Nature of Repayment (check Reimbursement Other (details 4A Payment Card Direct Payment ☐ ☐ as appropriate) Claim below) ☐ ☐ 4B Details (if selected Other) 5 Repayment Period If this is a repayment for an item funded by IPSA which you plan to use (or have used) for party political purposes, 6 please check the following box ☐ Repayment Details Form(s) & Line Number(s) Payment Date Description of Item(s) / Quote Reference Given (if applicable) 7 Repayment Method Reference Please make payments to IPSA’s bank account below with a reference that includes the MP’s initial and surname, and form number or the nature of the payment. For example, J DOE / 123456-2 or J DOE / OFFICE SUBLET. If you are repaying amounts owed as per your financial statement, please follow the guidance provided as per the statement. 8 Account Name IPSA ACCOUNT Bank Details Sort Code 60-70-80 Account Number 10012524 How Repayments Are Published on IPSA’s Publication Website If you are making a repayment for a Payment Card form and you originally selected claimed’ when you submitted the ‘not form, this repayment will not be published. All other repayments are published. The original payment is published with the status and then a copy of the line is published with the status Please bear in mind that publication takes place ‘paid’ ‘repaid’. three to four months in arrears, so this repayment will not be reflected on the publication website for some time. Repayments Form
Repayments Form Please submit form to info@theipsa.org.uk 1A MP Name 1B Payer (if different from 1A) 2 Constituency 3 Repayment Amount (£) 4A Nature of Repayment (check as appropriate) Reimbursement Claim ☐ Payment Card ☐ Direct Payment ☐ Other (details below) ☐ 4B Details (if selected Other) 5 Repayment Period 6 If this is a repayment for an item funded by IPSA which you plan to use (or have used) for party political purposes, please check the following box ☐ Repayment Details 7 Payment Date Form(s) & Line Number(s) (if applicable) Description of Item(s) / Quote Reference Given Repayment Method 8 Reference Please make payments to IPSA’s bank account below with a reference that includes the MP’s initial and surname, and form number or the nature of the payment. For example, J DOE / 123456-2 or J DOE / OFFICE SUBLET. If you are repaying amounts owed as per your financial statement, please follow the guidance provided as per the statement. Bank Details Account Name IPSA ACCOUNT Sort Code 60-70-80 Account Number 10012524 How Repayments Are Published on IPSA’s Publication Website If you are making a repayment for a Payment Card form and you originally selected ‘not claimed’ when you submitted the form, this repayment will not be published. All other repayments are published. The original payment is published with the status ‘paid’ and then a copy of the line is published with the status ‘repaid’. Please bear in mind that publication takes place three to four months in arrears, so this repayment will not be reflected on the publication website for some time. Repayments Form
ipsa-repayments-form.docx