Camden & Islington NHS Foundation Trust - TRAVEL & EXPENSES CLAIM FORM (For Trust employees on payroll only) EMPLOYEE DETAILS Title Surname Forename(s) _ _ _ _ _ _ _ _ _ - Assignment No. Band / Grade Job Title Home Address Base Address (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) Date Start Point End Point Details of journey / expense, Business Passenger Excess Excess Public Transport Costs Parking Other Expenses (e.g. Base) (e.g. Base) include passenger in (24p per mile) miles Miles Costs (train/tube/taxi /bus) Costs (Please specify) brackets Totals AUTHORISATION (For completion by Manager and Employee) Employee Declaration - I confirm that:
Camden & Islington NHS Foundation Trust - TRAVEL & EXPENSES CLAIM FORM (For Trust employees on payroll only) EMPLOYEE DETAILS Title Surname Forename(s) Assignment No. _ _ _ _ _ _ _ _ - _ Band / Grade Job Title Home Address Base Address (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) Date Start Point (e.g. Base) End Point (e.g. Base) Details of journey / expense, include passenger in brackets Business (24p per mile) Passenger miles Excess Miles Excess Costs Public Transport Costs (train/tube/taxi /bus) Parking Costs Other Expenses (Please specify) Totals AUTHORISATION (For completion by Manager and Employee) Employee Declaration - I confirm that:
CI%20Travel%20and%20Expense%20Claim%20Form%20-%20for%20employees%20on%20payroll.docx