EXPENSE CLAIM FORM
NURSE NAME ADDRESS
AVA PAYROLL NO WEEK NO
DATE OF SHIFT JOURNEY DETAILS FOR TRAVEL BY CAR MILEAGE
Car travel Total @ 40p
Over 10,000 miles Total @ 25p
Bicycle travel Total @ 20p
Mileage expense offset may be claimed at 40p per mile for the first 10,000 miles. All mileage above this may be claimed at 25p per mile.
Expenses claimed for traveling to and from the hospital must be submitted with your timesheet.
EXPENSE CLAIM FORM MUST CONTAINS DATES OF THE SHIFTS TO BE PROCESSED.
SHIFT START DATE: SHIFT END DATE:
Stationery (envelopes, stamps, faxes, photocopies)
Phone Top-up card or itemised phone bill
Travel to and from work with relevant receipts
Travel to induction, mandatory training or immunisation (only with relevant receipts)
Subsistence / Meals - NO RECEIPTS REQUIRED
Other, CRB, Training, Occ Health, Uniforms
Accommodation or staying with a friend (only when dates mentioned and full friends address provided)
Note - Receipts must be attached in order to process GRAND TOTAL
I declare that the above expenses were incurred wholly, necessarily, and exclusively in the execution of my duties
EXPENSE CLAIMS MUST BE SIGNED IN ORDER TO BE PROCESSED AND POSTED TO:
GREAT WEST HOUSE (GW1), BRENTFORD, LONDON TW8 9DF
PLEASE NOTE THAT FAX COPIES WILL NOT BE PROCESSED.