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ESRC TS claim form tcm8 3117 by YcZNzQ2v

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									                                                                                TS1 July 2012


                  ESRC claim for travel and other expenses
Please complete the following details clearly and return this claim form to your named
contact at ESRC. Please ensure that your full address and bank details are provided. We do
not store your bank details so these must be completed on every claim form.

Personal details
Title: Mr/Mrs/Miss/Ms/Dr/Professor/Other [delete as necessary or specify]
Forename(s):
Surname:

Permanent private address (inc postcode):

Normal place of work:

Email address (mandatory in case of query):

Are you a Council/Board/Panel/Committee member?                               [Yes/No]
Are you an external claimant / other?                                         [please specify]
Have you claimed Travel and Subsistence from ESRC before?                     [Yes/No]

Meeting details
Description of meeting(s) or visit(s)                  Location




Details of business expenses incurred
To be completed in full by claimant.
          Time*                                 Mode of           Mileage                        Amount
                      Full particulars of                                   Other expenses***
Date                                         transport and         (if by
                           journey**                                            (give details)
       Dep Arr                                   class              car)                           £   p




                                                                              Total expenses

* must be completed if claiming subsistence
** type of travel, address of overnight accommodation, reason for taxi where used
*** meals, accommodation, car parking etc




        Economic and Social Research Council, Polaris House, North Star Avenue, Swindon, SN2 1UJ
                              Telephone: 01793 413000 Fax: 01793 413001
                                                                                      TS1 July 2012

Declaration (claimant to complete)
I declare that:
     I made the journeys detailed in this claim and that the expenses charged have been
        actually and necessarily disbursed on Public Service
     the allowances claimed are in accordance with ESRC rules and that no other claim in
        respect of any of the items has been made or will be made against ESRC or any
        other organisation
     where overnight accommodation and expenses are claimed I necessarily stayed away
        from home and work overnight
     I hold a valid driving licence and my motor insurance policy covers the use of the
        vehicle for official business.

Signature of claimant:                                                             Date:
Print name:

Payment instructions (mandatory)
Payment will be made directly to the specified account. We do not store this information so
must be completed on every claim form.
Name of bank/building society
Branch name and address
8 digit account number
Sort code
Account holder’s name

Non UK banks
SWIFT code
IBAN
Bank currency
Routing number

Claimants please return this completed form to your named contact at ESRC.

--------------------------------------------------------------------------------------------------------------------
For ESRC use only
I confirm that:
      the claimant attended the meeting(s)
      the claim adds up and receipts reconcile to the claim
      the claim complies with ESRC’s Travel and Subsistence Policy and all required
         information has been provided
      the claim represents VFM.

Authorised by:                                                                     Date: __/__/20__
Print name:

For claims over £500:
Countersigned by (Grade F or above):                                               Date:     __/__/20__
Print name:
         Economic and Social Research Council, Polaris House, North Star Avenue, Swindon, SN2 1UJ
                               Telephone: 01793 413000 Fax: 01793 413001

								
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