End of Tenancy Letter - Excel

					    Eligibility Form to Claim Reimbursement of Relocation and Associated Expenses

    Before completing, please see the 'Notes for completing the relocation eligibility form' on page 4.

    To be completed in all cases prior to submitting any claim for reimbursement of removal or excess travel
    expenses, to enable the London Deanery to assess eligibility. Trainees will be notified in writing of the
    outcome of this request.

    Please indicate the nature of the expenses you wish to claim:
                                                                                         Please tick
                Removal costs
                Relocation costs (including house purchase costs)
                Excess travel costs
                Continuing commitments (e.g. rent costs)
                Are these costs associated with a current or future post?                   current / future
                                                                                            (please indicate)
    SECTION 1: Personal Details

    Title:                             Family Name:
    First Names:
    Address (for future correspondence):


                                                                      Post code:
    Email:                                                      Telephone:

                             National Training Number:
         Training programme, Specialty and Grade:
                         Start date on this programme:
             Foundation trainees please state medical school:

    SECTION 2: Details of Rotations

    Details of rotations to date:
    Start date:            End date:              Hospital:




                                       Current Employer:
                              Start date in current post:
                         Planned end date of this post:



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      If GP, are you in hospital or general practice:
    Details of future rotations:
    Start date:            End date:            Hospital:




              My base hospital is:
                     As per section:                    A B C D (please indicate)
    Please see the notes for help on establishing which is your base hospital.

    SECTION 3: Accommodation

    Present/Previous Accommodation:

    Address:


                                                                   Post code:

                                                  Owner Occupied      Rented Furnished   Rented Unfurnished
             Type of Tenancy (select one):
                                                     Freehold            Leasehold
                     Type of Accommodation           Detached          Semi-detached         Terraced
                                (select one):          Flat              Maisonette            Studio
                          Number of rooms:
         Distance from new place of work:
          Is this hospital accommodation?

    Proposed/New Accommodation:

    Address:


                                                                   Post code:

                                                  Owner Occupied      Rented Furnished   Rented Unfurnished
             Type of Tenancy (select one):
                                                     Freehold            Leasehold
                     Type of Accommodation           Detached          Semi-detached         Terraced
                                (select one):          Flat              Maisonette            Studio
                          Number of rooms:
         Distance from new place of work:
          Is this hospital accommodation?


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    SECTION 4: Previous Claims
    Please enter full details of all the previous claims you have made from Foundation Year 1 to date. If you
    haven't made any previous claims, please state nil. Please do not include claims related to work to clinic
    travel or interviews.

    Trust                               Date of Claim             Amount             Type of claim (removals /
                                                                                        excess travel / other)




    SECTION 5: Excess Travel Details
    If you are claiming excess travel, please complete the following:

    Home to base hospital (one way)
    Home to new place of work (one way)
    Excess mileage
    Current method of transport
    Proposed method of transport

    SECTION 6: Declaration
    Please note that, if travelling by public transport receipts will be required.

    NB. The maximum payable under these guidelines to any trainee is £8000 over the whole of the period
    employed on a recognised training programme from the start of Foundation year 1 (FY1) to Certificate of
    Completion of Training (CCT).

    Declaration:

    I confirm that the information provided is accurate and complete; that all information supplied may be
    checked; that I may be asked to provide further details to assist with verification; and that a claim that
    misrepresents the facts or my entitlement may result in disciplinary action.

    Signed:                                                            Date:
    Print name:

    In order to avoid any delays in processing your form, we strongly recommend that you attach a
    covering letter to this form, giving any pertinent details that you feel will support your eligibility.
    Completed forms should be returned by post (emails will not be accepted) to:

    The Relocation Team
    Finance Department
    4th Floor
    The London Deanery
    Stewart House
    32 Russell Square
    London
    WC1B 5DN

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                            Notes for completing the relocation eligibility form

    Section 1: Personal Details

    - Please ensure that you include your National Training Number, as we are unable to meet any claims
    without this information. If you do not have one yet, you will need to provide it when you submit your
    claim form.

    Section 2 - Details of Rotations

    - Please include full details of all your previous rotations since starting your programme, and any future
    rotations (if known).

     - Base Hospital:
    Please enter your base hospital, as per one of the following sections. Please also state the relevant
    section.
    A) If you have previously claimed relocation expenses whilst in this training grade then the last hospital
    that paid you to relocate is your base hospital.
    B) If you know that you will spend more than half of your training programme at one particular hospital,
    then that hospital can be your base hospital if (A) above does not apply.
    C) If you do not know where you will rotate to next and neither (A) nor (B) apply, then the first hospital
    on your rotation is your base hospital.
    D) You may select a base hospital convenient to your home address if none of the above apply and you
    provide verification that you will definitely be rotated to that hospital (as opposed to it being a possible
    post on a rotation).

    Note: It is not appropriate for trainees to select their base hospital with a view to maximising their
    excess travel payments.

    Section 3: Accommodation

    - Only fill in section 3 if you are claiming for relocation or removal costs. If you are only claiming for
    excess travel then you can leave this section blank.

    Section 4: Previous Claims

    - Please ensure that you include the details of all previous claims made from the start of your FY1 year
    to date, regardless of which trust or deanery the claim was made from.

    Section 5: Excess Travel Details

    - Please note that we use RAC route planner to determine mileage and any such claims will be paid
    according to the mileage calculated on this basis.




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