ADDITIONAL HOURS (if additional hours are not required please leave blank) Please provide an explanation of and give evidence for costs: ‘other’ BASIC MONTHLY PAY OTHER EPA/APA HOURS AVAILABILITY SUPPLEMENT Please provide your information below: Name TOTAL PAY Job title / department Email address EMPLOYER NI EMPLOYER SUPERANNUATION FOR INTERNAL NES USE ONLY NES finance TOTAL COSTS Name Date * TOTAL DURATION IN MONTHS Email TOTAL COSTS PER MONTH TOTAL AMOUNT CLAIMED Comments *part months should be expressed as a fraction of a month (i.e. 7.25 = 7 months, 1 week) TOTAL AMOUNT CLAIMED - BACK FILL + ADDITIONAL HOURS
ADDITIONAL HOURS (if additional hours are not required please leave blank) BASIC MONTHLY PAY OTHER EPA/APA HOURS AVAILABILITY SUPPLEMENT TOTAL PAY EMPLOYER NI EMPLOYER SUPERANNUATION TOTAL COSTS TOTAL DURATION IN MONTHS * TOTAL COSTS PER MONTH TOTAL AMOUNT CLAIMED *part months should be expressed as a fraction of a month (i.e. 7.25 = 7 months, 1 week) TOTAL AMOUNT CLAIMED - BACK FILL + ADDITIONAL HOURS Please provide an explanation of and give evidence for ‘other’ costs: Please provide your information below: Name Job title / department Email address FOR INTERNAL NES USE ONLY NES finance Name Date Email Comments
d1-sas-backfill-costings-form.docx