Mileage-Claim-Form by qingyunliuliu

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									                  TRUST:                              THAMES VALLEY PRIMARY CARE AGENCY              ---   GP SPECIALTY TRAINEE

                                                                                 MOTOR VEHICLE ALLOWANCE CLAIM
PERSONAL DETAILS:                                                                                                                     CAR DETAILS:
DEPARTMENT: TVPCA                                           N   Oxford Deanery                                                        Make:
TELEPHONE No.                                                                                                                         Model:
POST HELD:    GP SPECIALTY TRAINEE                        Home to Base Mileage (Practice) =                                           Engine Capacity:
SURNAME:                                                  Home to Day Release Mileage =                                               Registration No:
FORENAME(S):                                              Base to Day Release Mileage =                                               Diesel:                    Y/N
HOME ADDRESS:                                                                                                                         CLAIM TYPE: Enter "Y" as appropriate
                                                          CLAIM MONTH:                                                                Standard user.
                                                                                                                                      Regular user.



CLAIM SUMMARY:
A GP Specialty Trainee can claim mileage when they are                                  I CERTIFY THAT:
required by the practice to travel on practice business                                 1. The amounts claimed are in accordance with the current regulations and are in
                                                                                        respect of expenses actually and necessarily incurred whilst engaged on the
GP Specialty Trainees cannot claim for home to practice (base) travel                   business stated.
unless they subsequently use their car for work, in which case                          2. The insurance policy in respect of the car shown above provides cover whilst
they can claim for the business mileage plus their home to base                         the car is used on official business.
return, subject to a maximum of 20 miles return.
                                                                                        Signature:………………………………...……….



                                                                                        Date:………………………..

                                                                                        TO BE COMPLETED BY THE TRAINER
CLAIM TOTALS:       Official use only
                                                                                        To the best of my knowledge the claimant was engaged on the business(es)
                                  p                £.pp                                 stated and the amounts claimed are in accordance with the current regulations.
            Miles at pence:                               Mileage Claim
            Miles at pence:                               @ Public Tnspt Rate                                      Print
                                                                                        Signature:………………………………………..… Name:…………………………………
            Miles at pence:                               Passenger Rate

                                                                                        Designation:………………………………………
             regular user lump sum:
                                                                                        Date:…………………………

                      CLAIM TOTAL:                                                      Please return to 7-9 Cremyll Road, Reading, Berkshire. RG1 8NQ
NAME / ORGANISATION :         THAMES VALLEY PRIMARY CARE AGENCY       ---   GP SPECIALTY TRAINEE
CONTINUATION SHEET 1                                                                                                     Expense Claim Details for:
                                                                                                                                                              X or Tick if
            Reason for travel                                                          Transport Actual Miles Miles claimed          Passengers                @ Public
  Date    eg. Home visit, day release,               Journey Details                     Used                                                                   Trnsprt
                home to base                 (From - To including postcode)                                                          Name             Miles      Rates




PLEASE CROSS THROUGH UNUSED LINES                                                    BROUGHT FORWARD FROM SHEET 2
                                                                                 CARRIED FORWARD TO SUMMARY SHEET
NAME / ORGANISATION :           THAMES VALLEY PRIMARY CARE AGENCY        ---    GP SPECIALTY TRAINEE
CONTINUATION SHEET 2                                                                                                      Expense Claim Details for:
                                                                                                                                                               X or Tick if
            Reason for travel                                                              Transport Actual Miles Miles claimed         Passengers              @ Public
  Date    eg. Home visit, day release,                 Journey Details                       Used                                                               Trnsprt
                 home to base                  (From - To including postcode)                                                          Name            Miles     Rates




PLEASE CROSS THROUGH UNUSED LINES                                                            CARRIED FORWARD TO SHEET 1                                 0           0
NAME / ORGANISATION :   THAMES VALLEY PRIMARY CARE AGENCY    ---   GP SPECIALTY TRAINEE
CONTINUATION SHEET 2                                                                                            Expense Claim Details for:
                                                                                      A =Actual Miles Travelled                                    X or Tick if
                                                                            Transport         B =Miles if To/From           Passengers              @ Public
  Date    Reason for travel                Journey Details                    Used            Base       C, Lesser                                  Trnsprt
                                                                                                         of A or B         Name              Miles   Rates




PLEASE CROSS THROUGH UNUSED LINES                                   CARRIED FORWARD TO SHEET 1

								
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