UoN CREST

The University of Nottingham Staff Expenses Claim Form

Signatures must NOT be written in BLACK ink.

Finance.EXP1.LATEX2e

Mandatory Information	School / Department or Division	Location (e.g. S/Bon, QMC., etc.)	Payroll Number
Claimants Name (Block Capitals)	Signature:	Job Title:	Date:
Contact Details for Claimant	Email Address:	Telephone Number (Extension)
Car Details (if claiming mileage)	Registration number:	Engine size:	*Lease Car *Casual User
Authorised by (Block Capitals)	Signature:	Job Title:	Date:

Mileage

Date	Reason for and Details of Journey (Including Start and Finish Points)	Miles	Project	Activity
	Total Miles Claimed =
	@ ppm =	£

Other Items - (Additional Information is Required for Meetings and Entertainment- See form Finance.EXP1a)

Date	Details of and reason for Claim (for Subsistence Claims include Location)	Time Left	Time Returned	Amount in Foreign Currency	Amount in £(inc VAT)	Project	Activity
	Total £Claimed =				£

Finance Department Use Only
Date Received:	Checked By:

Declaration by claimant
1. By signing this claim form, I certify that the expenses have been wholly, exclusively and necessarily incurred in the performance of my duties at the University of Nottingham.
2. I confirm that prior to undertaking a journey on University business: (a) I have valid business motor insurance, (b) the vehicle is road worthy and is either less than 3 years old or has a valid MOT certificate, (c) I have a valid UK driving license and know of no medical reason why I should not drive.

Summary
(complete this section on Sterling only.)

£
	Mileage
	Other Items
	Less Advance
	No. A

A falsely completed claim form will amount to gross misconduct.