Nsw Journey Claim Form - DOC by gsn61905


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									Travel Claim Form Instructions                                                Page 1

1.   If claiming for travel mileage in a private motor vehicle, you must complete
     form PRIOR to traveling. If your supervisor’s signature post-dates the travel
     date, please include a brief explanation.

2.   Please ensure you attach original receipts, not photocopies, totaling the exact
     amount you are claiming.

3.   Do not fax your travel claim as only originals will be processed.

4.   Ensure you keep a copy of your claim and receipts.

5.   If your rail ticket was captured, or you did not obtain a Cab receipt, please
     note this under “Reason for Travel” (last column).

6.   Note that if any part of the claim is incomplete it will be returned to you –
     make sure you complete the travel diary and sign it!!

7.   Please submit within one month of the activity.

8.   If you are claiming for private motor vehicle please ensure that you include a
     copy of your current:
      Drivers licence;
      Registration; and
      Comprehensive Insurance Policy.

9. The Auditor-General has stipulated that your travel claim has a brief statement
   attached from you that justifies that the use of private motor vehicle is the most
   cost effective means of transport.

10. Please calculate your travel claim at the following rates:
     Under 1600cc = 21.5c
     1600 - 2700cc = 25.5c
     Over 2700cc       = 27.5c

Please return completed claim to:
School Leadership Development Unit
NSW Department of Education and Training
Private Bag 3, 3A Smalls Road
                                                                                                                                  Page 2
                        NSW Department of Education & Training
Instructions :- Complete your Perso nal Details, Vehicle & Insura nce Details and your Statement on the reverse
                of this form, then pass it to your Manager for processing.
Please Note :- Insurance Renewals must be produced, but all approvals are valid for a maximum period of one
                (1) year.
Personal Details
Last Name:                          First Name :                            Serial No.

Residential Address:                                                        Home Phone No.
Position:                                                                   Work Phone No.
Vehicle Details
Make                                                                        Year & Model
Registration No.                    Date of Purchase                        Engine Capacity
Insurance Details
Name of Insurance Company                                         Comprehensi ve Policy No.
Renewal Date
Does your Comp rehensive Insurance include a clause indemnify ing the Cro wn against liab ility
                                                   If No, have you approached the
             Yes                     No            Company seeking such Indemnity                     Yes                        No
Do you own or are buying the vehicle?
                                                   If No, obtain a written authority to use
                                                   the vehicle on Official Business from
              Yes                  No              the owner                              Yes                                    No
Has the Insurance Company been formally advised of your use of the vehicle on Official Business?
              Yes                   No

Conditions for Payment
Specified J ourney Rates are pai d to officers who are raveled d to use their pri vate motor vehicle to travel
official business intermittentl y as opposed to regular use for which Official B usiness Rates are pai d.
The rate pai d is based on the distance raveled on a tri p by tri p basis on official business .
Applicant’s Statement
I have attached:                        Please tick appropriate bo xes
                         Current Renewal Notice with evidence of pay ment, AND
       Either            Current Insurance Policy endorsed with Crown Indemnity
        Or               Co mprehensive Insurance Policy plus letter fro m Insurer indemnifying Crown
I understand the Departmental conditions on the usage of Private Vehicles on Official Business and I have examined
                         Determination 37 of the Teaching Services Act, 1980
                         Clause 45 of the Public Service (General) Regulat ions 1988

Applicants Signature:                                                                         Date:          /       /

Supervisor’s Recommendation
NB: Supervisors should always consider all available modes of transport and choose private motor vehicles only if
it is the most efficient and cost effective method

Name:                                                Signature                                        Date           /   /

Delegate’s Approval
APPROVED UNDER DELEGA TION – Applicants must produce Insurance Renewal Docu ments and note that
all approvals are valid for a maximu m period of one (1) year only.

                                                                                                      Date       /           /
                                                                                                                                                                  Page 3
                                              NSW Department of Education and Training
                                                      Travel Claim Voucher
Clai mant Details
                                          Surname                                                                     Other Names
Serial No                                 Address
                                          Position Hel d                                                              HQ/School
Indicate if you have
1. Corporate Card                                                                                                 Period of Cl aim
2. Temp Advance                                                              From:                                               To:

      1. Subsistence Allowance
                                                                                                             $              c                               $               c
                      days @                                                  per day
                      hours @                                                 her hour
                      days @                                                  per day
                      hours @                                                 per hour
      Total Subsistance Allowance

      2. Actual Expenses Claim as per diary
                                   ( attach receipts )

      3. Conveyance - Use of Car

      Engine Capacity                                              cc

      Total kilometres travelled this month as per di ary                                                                           km

      Distance from residence to HQ/School                                                                                          km

      Distance Clai m                                           km @

      4. Meals shown on di ary                                     (one day trips ONLY)

      5. Other Expenses                                                               Item                   $              c
              Coach or Motor Car Hire,
              Plane, Bus,Taxi,Train

                                                                                                                    Total                       $
                                                                                              Less Advance/Corporate Card                       $
                                                                                                               Net Total                        $
Office Use Only                                                                                                                     Voucher No
Vendor No                                                                                    Name                                                                Amount

Invoice No                                                                                 Resp Centre
Payment Terms                                                                     DS E Contact                                  Payment Type

Cheque Remark
                                               Account Number                                                                                  Amount


Confir med that JDE has no record of a P O relating to this payment; Certified correct under Section 12 of       Certified correct under Section 13 of the P ublic Finance and Audit
thePublic Finance and Audit Act, 1983, (where no purchase order has been raised ) as to:                         Act, 1983, and in accordance with the Treasurer's Directions as to:

                                                                                                                 Performance of Service :
                                                                                                                 Rates of Charge :
                   Funds Available :                                                                             Co mputations & Castings:
             Appropriation Correct :                                                                             Checked against Double Pay ment:
     Authority to incur expenditure:                                                                             Marked off against Authority:
                                                                                                                                                                                                       Page 4

DIARY FOR PERIOD ENDED                                       DAY…………… MONTH…………… YEAR……………
                                                                                                                                Accom                                      Fares,
 Day                                                                                      Less        Kilo-
          Departed         Time                             Time        Kilometres                             Days    Hours    as per     Breakfast   Lunch    Dinner      Other
  of                                     Arrived at                                       Daily      metres                                                                               Reason for Travel
            from          am/pm                            am/pm         Travelled                            Absent   Absent   Receipt       $          $         $      Expenses
Month                                                                                   Deduction   Payable
                                                                                                                                  $                                           $


        I certify that the details shown on the diary are a correct record of my                                       (ONE DAY TRIPS ONLY) I CERTIFY that I actually paid …………………
        official movements, that the distance travelled w as in connection w ith bona fide                             for lunches as shown on diary and I claim refund of ………………………..
        official business and was necessary for the economical performance of my duties                                additional expense beyond what would have normally been incurred
        …………………………………………………………………….                                                      / /                           …………………………………………………………….

        Signature of Claimant                                                           Date                           Signature of Claimant

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