Online expense form

Claims for the reimbursement of travel costs should be supported by receipts, unless these are not available (please indicate if this is the case).

If you are returning your form via email (preferred method, in Excel format), please scan or photograph the receipts and attach them to your claim submission email.

Please Note: Expenses will be paid via BACS

Your Details

First Name

Surname

Address Line 1

Address Line 2

Town

Post Code

Email Address

Telephone No.

Bank Account Details

Sort Code (no dashes/spaces)

Account No.

Bank/Building Society Name

Bank Account Name

Building Society Roll No.

Expense Detail

Date of meeting/hearing

Date of travel 1 (if different to the above)

Date of travel 2 (if different to the above)

Public transport costs 1 (please state whether by train, bus, etc.)

Amount (£)

Expense Description

Public transport costs 2 (please state whether by train, bus, etc.)

Amount (£)

Expense Description

Private vehicle costs (please state the mileage [paid at £0.32/mile])

Amount (£)

Expense Description (Mileage)

Incidental expenses 1 (please state what was purchased)

Amount (£)

Expense Description

Incidental expenses 2 (please state what was purchased)

Amount (£)

Expense Description

Total being claimed (£)

File uploads

If you are completing this form at the Inquiry office in Fleetbank you can ignore this section and simply hand your receipts to the Inquiry staff present.

Unlimited number of files can be uploaded to this field.
5 MB limit.
Allowed types: gif, jpg, png, txt, odf, pdf, doc, docx, ppt, pptx, xls, xlsx.

Declaration

I declare this claim is accurate. If claiming mileage, I hold a valid driving licence and car insurance. All relevant receipts are submitted with this expenses claim.

Signature

Sign above

Date

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