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Relocation Expenses Claim Form (DOC)

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					                        Department of Education

                                                               Relocation Expenses Claim Form
                        See Policy


                        Name……………………………Given Names ...............................................................................

                        Employee Number………………………………

                        Please indicate which section/s of the policy relates to your claim:
                        Removal – Furniture and Personal Effects                                                           Private Vehicle Allowance                             
                        Special Accommodation Allowance                                                                    Accommodation En Route                                
HRM Branch Authorised




                        Depreciation Allowance                                                                             Property Sale                                         
                        Property Purchase                                                                                  Removal of Pets                                       

                        Details of Transfer/Promotion/Appointment

                        From (position held/location) ...............................................................................................................

                        To (new position/location) .....................................................................................................................

                        Transfer/Promotion/Appointment effective from .............................................................................

                        Residential address in old locality .......................................................................................................

                        .....................................................................................................................................................................

                        Residential address in new locality .....................................................................................................

                        .....................................................................................................................................................................

                        Telephone contact number (and dates applicable)

                        .....................................................................................................................................................................

                        Residential Details (You Are/Will Be Residing In)

                                                                                                        Old locality                                                 New locality
                        Own Home
                        Departmental Accommodation
                        Rented Accommodation
                        Private Board
                        Other (please specify)



                                                                                                  (May 2010)                                                                                Page 1 of 12
                        Department of Education

                                                                                 Removal – Furniture
                                                                                 and Personal Effects
                        Quotes Obtained From Removalists (Quotes Must Be Attached)

                        1 ............................................................................................................. (name of removalist/amount)

                        2 ............................................................................................................. (name of removalist/amount)

                        3 ............................................................................................................. (name of removalist/amount)
HRM Branch Authorised




                        Proposed date of move .........................................................................................................................


                        Details of Persons Residing with the Employee:

                                                                                                                Relationship to
                               Family Name                                 Given Name                                                                   Dependant Y/N
                                                                                                                  Employee




                        Signature of Employee ...........................................................................................................................................

                        Date ............................................................................

                        Personal Information Protection Statement

                        Personal information will be collected from you through this form for the purpose of obtaining employee and relocation related details and will be used
                        by the Department of Education for processing your relocation expenses claim and other purposes permitted by the State Service Act 2000 and
                        regulations and directions made by or under the Act.

                        Failure to provide this information may result in the department being unable to process your relocation expenses claim. Personal information will be
                        managed in accordance with the Personal Information Protection Act 2004 and may be accessed by the individual to whom it relates on request to the
                        Department of Education. You may be charged a fee for this service.

                        You can obtain a copy of the Department’s Personal Information Protection Policy on request to Human Resources Management Branch at
                        HRM@education.tas.gov.au or at http://www.education.tas.gov.au/dept/about/legislation/pip/policy.


                        This form should be returned to the Human Resources Management Branch
                        (Recruitment Services) by:

                        Post:                                                  Fax:                                     or Email (scanned documents):
                        GPO Box 169                                            (03) 6233 0566                           recruitment@education.tas.gov.au
                        HOBART TAS 7001

                                                                                              (May 2010)                                                                   Page 2 of 12
                        Department of Education

                                                                           Private Vehicle Allowance

                        Family Name…………………………..Given Names .....................................................................

                        Employee Number…………………………………..


                        Vehicle 1

                        Make, Model and Year
HRM Branch Authorised




                        .....................................................................................................................................................................


                        Registration number ....................................................................

                        Engine capacity ..............................................................................

                        Relocation from ........................................................... to ...................................................................



                        Vehicle 2

                        Make, Model and Year

                        .....................................................................................................................................................................

                        Registration number ....................................................................

                        Engine capacity ..............................................................................

                        Relocation from ........................................................... to ...................................................................



                        This form should be returned to the Human Resources Management Branch
                        (Recruitment Services) by:

                        Post:                                                     Fax:                                             or Email (scanned documents):
                        GPO Box 169                                               (03) 6233 0566                                   recruitment@education.tas.gov.au
                        HOBART TAS 7001




                                                                                                  (May 2010)                                                                                Page 3 of 12
                        Department of Education


                                                           Special Accommodation Allowance

                        These costs will not be paid unless prior approval has been granted


                        Family Name…………………………..Given Names .....................................................................

                        Employee Number…………………………………..

                        Name of hotel, motel .............................................................................................................................
HRM Branch Authorised




                        Location .....................................................................................................................................................

                        Dates ..........................................................................................................................................................

                        Total cost $ ....................................................................................


                        Names of Adults and Children Concerned

                        Names                                                                                     Relationship to Employee




                        Please attach invoice and proof of payment.



                        This form should be returned to the Human Resources Management Branch
                        (Recruitment Services) by:

                        Post:                                                   Fax:                                            or Email (scanned documents):
                        GPO Box 169                                             (03) 6233 0566                                  recruitment@education.tas.gov.au
                        HOBART TAS 7001




                                                                                                (May 2010)                                                                             Page 4 of 12
                        Department of Education

                                                                           Accommodation
                                                                      and Meal Expenses En Route
                        These costs will not be paid unless prior approval has been granted

                        Family Name…………………………..Given Names .....................................................................

                        Employee Number…………………………………..

                        Name of accommodation ......................................................................................................................

                        Location .....................................................................................................................................................
HRM Branch Authorised




                        Dates ..........................................................................................................................................................

                        Cost of Accommodation $.........................................................

                        Cost of Meals:

                        Breakfast $ .....................................................................................

                        Lunch $ ...........................................................................................

                        Dinner $ .........................................................................................


                        Names of Adults and Children Concerned

                        Names                                                                                     Relationship to Employee




                        Please attach invoice and proof of payment.



                        This form should be returned to the Human Resources Management Branch
                        (Recruitment Services) by:

                        Post:                                                   Fax:                                            or Email (scanned documents):
                        GPO Box 169                                             (03) 6233 0566                                  recruitment@education.tas.gov.au
                        HOBART TAS 7001

                                                                                                (May 2010)                                                                             Page 5 of 12
                        Department of Education

                                                                              Depreciation Allowance

                        Family Name…………………………..Given Names .....................................................................

                        Employee Number…………………………………..
HRM Branch Authorised




                        Amount of departmental insurance for relocation of furniture and personal effects

                        $...................................................................................................


                        Amount of depreciation claimed $ .................................................................................


                        Note: Employees must provide the Department with a copy of their current home contents
                        insurance policy.


                        Please sign to certify that your furniture and effects were moved satisfactorily to enable
                        payment to the removalists.


                        Name of removal company ..............................................................................................

                        Date of move .......................................................................................................................

                        Signature ...............................................................................................................................

                        Date ............................................................................................




                        This form should be returned to the Human Resources Management Branch
                        (Recruitment Services) by:

                        Post:                                                    Fax:                                          or Email (scanned documents):
                        GPO Box 169                                              (03) 6233 0566                                recruitment@education.tas.gov.au
                        HOBART TAS 7001




                                                                                                 (May 2010)                                                         Page 6 of 12
                        Department of Education

                                                     Reimbursement of Expenses Incurred In
                                                             the Sale of a Property

                        Family Name…………………………..Given Names .....................................................................
HRM Branch Authorised




                        Employee Number…………………………………..

                        Details of property (land only, house, flat, apartment)

                        .....................................................................................................................................................................

                        Did the property/dwelling stand on its own allotment of land? (Please tick) Yes  No 

                        Full address of property
                        .....................................................................................................................................................................

                        .....................................................................................................................................................................

                        Name of legal owner – if employee was not the sole owner state full name of all parties with interest
                        in the property together with the proportion to which each was entitled

                        .....................................................................................................................................................................

                        .....................................................................................................................................................................

                        Date property was purchased .........................................................................................

                        Date of contract of sale ....................................................................................................

                        Date sale completed ..........................................................................................................

                        Actual payments made (proof of payment to be supplied)

                                                                Item                                                                                    $ Amount
                        Legal fees
                        Agent’s commission
                        Stamp duty
                        Title fees
                        Fees for the discharge of first mortgage
                        Newspaper advertising (max $500)
                        Total


                                                                                                  (May 2010)                                                                                Page 7 of 12
                        This form should be returned to the Human Resources Management Branch
                        (Recruitment Services) by:

                        Post:                                                       Fax:                                           or Email (scanned documents):
                        GPO Box 169                                                 (03) 6233 0566                                 recruitment@education.tas.gov.au
                        HOBART TAS 7001
                        Department of Education


                                                    Reimbursement of Costs Associated with
                                                          the Purchase of a Property
HRM Branch Authorised




                        Authority Number .......................................................................

                        Family Name…………………………..Given Names .....................................................................

                        Employee Number…………………………………..


                        Details of property (land, house, flat, apartment)

                        .....................................................................................................................................................................

                        Does house etc stand on its own allotment of land?

                        .....................................................................................................................................................................

                        Full address of property

                        .....................................................................................................................................................................

                        .....................................................................................................................................................................

                        Date purchase completed......................................................................................................................

                        Date house etc occupied .......................................................................................................................

                        Is the purchase of this property your first home purchase?

                        Yes/No .................................................................................................


                        Do you currently own any other residence (other than the one which you intend to sell and claim a
                        property sale allowance for)?

                        Yes/No .......................................................................................


                        If yes, please provide further details
                                                                                                    (May 2010)                                                                              Page 8 of 12
                        .....................................................................................................................................................................

                        .....................................................................................................................................................................

                        .....................................................................................................................................................................

                        .....................................................................................................................................................................


                        If land only purchased:

                                    Date building contract to be signed ......................................................................................................

                                    Date building due for completion .........................................................................................................
HRM Branch Authorised




                        Actual payments made (proof of payment to be supplied)

                                                               Item                                                                                    $ Amount
                        Legal fees
                        Stamp duty
                        Title fees
                        Miscellaneous fees
                        Fees for the execution of a first mortgage
                        Total




                        This form should be returned to the Human Resources Management Branch
                        (Recruitment Services) by:

                        Post:                                                     Fax:                                             or Email (scanned documents):
                        GPO Box 169                                               (03) 6233 0566                                   recruitment@education.tas.gov.au
                        HOBART TAS 7001



                                                                                                  (May 2010)                                                                                Page 9 of 12
                        Department of Education

                                                                                           Removal of Pets
                        Note: “pets” are defined as dogs, cats, birds or other domestic animals kept by the household and
HRM Branch Authorised




                        do not include domesticated livestock, native or equine animals.

                        (These costs will not be paid unless prior approval has been granted)

                        Authority Number .......................................................................

                        Family Name…………………………..Given Names .....................................................................

                        Employee Number…………………………………..


                        Details of Pets Concerned (please attach a separate sheet if necessary)

                        .....................................................................................................................................................................
                        .....................................................................................................................................................................


                        Details of Boarding Costs

                        Name and location of boarding kennel/cattery (or similar)...........................................................

                        .....................................................................................................................................................................

                        Dates ..........................................................................................................................................................

                        Total cost $ ....................................................................................

                        Details of Pet Transport Costs

                        Name of transport carrier.....................................................................................................................

                        Dates ..........................................................................................................................................................

                        Total cost $ ....................................................................................

                        Please attach invoice and proof of payment.


                                                                                                  (May 2010)                                                                              Page 10 of 12
                        This form should be returned to the Human Resources Management Branch
                        (Recruitment Services) by:

                        Post:                                                      Fax:                                             or Email (scanned documents):
                        GPO Box 169                                                (03) 6233 0566                                   recruitment@education.tas.gov.au
                        HOBART TAS 7001




                        Department of Education

                                                                                                   Declaration
HRM Branch Authorised




                        I ....................................................................................................................................................................
                                                                                                   (Name of Employee)

                        of .................................................................................................................................................................

                        in Tasmania do solemnly and sincerely declare that the information given in respect of the claims I
                        have made is to the best of my knowledge and belief, true in every respect and has been incurred as
                        a direct result of my relocation.




                        Signature .................................................................................................. Date .....................................................


                        Witness..................................................................................................... Date .....................................................




                        This declaration should be returned to the Human Resources Management Branch
                        (Recruitment Services) by:

                        Post:                                                      Fax:                                             or Email (scanned documents):
                        GPO Box 169                                                (03) 6233 0566                                   recruitment@education.tas.gov.au
                                                                                                   (May 2010)                                                                               Page 11 of 12
                        HOBART TAS 7001
HRM Branch Authorised




                                          (May 2010)   Page 12 of 12

				
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