ࡱ>  c 0 #bjbj QbQbh8jj)j)000D11112 1i$44444VVV~~~~~~~$CX0VKP:VVVj)j)44#YYYVjj)L404~YV~YYTu0. x4_[:V6v$~90iv@%XHx0xVVYVVVVVYVVViVVVVVVVVVVVVVB 0(: EXPENSES CLAIM FORM NON STAFF (NOT UoS STUDENTS) This form is for use by individuals who are non University of 91̽ staff to claim reimbursement of expenses in a personal capacity and not on behalf of an employer institution (complete section 1). Payment is made directly to your bank account and you should provide bank details for your PERSONAL bank account in the Bank Account Information section (complete section 2). 1Your Expenses Claim Please complete this form using CAPITAL LETTERS. Sign and date it and pass to your named University of 91̽ contact, or University of 91̽ departmental office for authorising and processing.  Claimant Full Name Address  Post Code:  E-mail  Status (Note 2) Student No: (If applicable) I certify that the expenses claimed on this form are correct.  Signature of Claimant Date Purpose for Expenses Incurred (see Guidance note 3) DatesDescription of expenses (see Guidance note 4)Foreign Currency Type AmountAmount GBP pForeign currency conversion used For University of 91̽ departmental office use only (When completed and authorised return to Payroll and Expenses, Department of Finance)Cost Centre or WBS ElementExpense typeExpense amounts (Gross)VAT CodeReceipt attached pXX pXX pXX pXX pXX pXXTotal gross claim p Authorised Signatory  Print Name Date 2Your Bank Account informationChoose one Option only  Option 1 - Payment to UK Bank or Building Society  Name(s) of Account Holder(s): Name of your Bank or Building Society:  Address of your Bank or Building Society   Branch Sort Code: - - Account Number: Roll Number (Building Society):   Option 2 Payment to an Overseas Bank Account (see guidance note 5) Beneficiary Bank Details  Name(s) of Account Holder(s):  Name of your Bank: Address of your Bank:  Account Number: Account Currency:  Bank Code Number: SWIFT/BIC No: (E.g. ABA Routing code, Transit Number, BSB Code):  IBAN Number (Compulsory for all EU Bank accounts): Intermediary/Correspondent Bank Details (if applicable)  Name of Bank: SWIFT/BIC No: Account Number: Any additional information you wish to provide to ensure payment reaches you correctly:   Please sign and date to confirm account details provided in the chosen option above are correct  Signature of claimant Date Guidance Notes FOR COMPLETION OF Non Staff EXPENSES CLAIM FORM 91̽s payment records may be audited by HM Revenue & Customs. Details provided on this claim form must be complete and accurate. If the details and supporting documents requested are not provided the claim form will be returned to the authorised signatory and may delay payment or result in the claim being rejected. Full details of the nature and purpose of the expenditure should be provided on Page 1. Expenses that are not supported by original receipts will not be reimbursed. Credit / debit card receipts will not be accepted as they do not itemise the goods and/or services purchased. Payment cannot be made using this form if the amount claimed is to be paid to an organisation or your employer institution and not to you personally. You must speak to your University of 91̽ (the University) contact and arrange for an invoice for the amount due to be sent by that organisation / institution to the relevant University contact. Your University contact will provide a Purchase Order number which must be quoted on the invoice. STATUS OF EXTERNAL CLAIMANT: Enter your personal status in the box. Student (include the name of the University attended)Interviewee Visiting academic (include the name of your home institution)Emeritus Professor/other retireesOther (include the name of your employer institution or organisation) PURPOSE OF EXPENSE: Please state the reason for incurring the expenditure. For example if the costs were incurred in attending a seminar or Field Trip provide full details: ESRC seminar in 91̽, October 2012; or Costs of attending for interview in Department of History, October 2012. DESCRIPTION OF EXPENSES: Please provide a clear description of the actual costs incurred and the amount per item. If there are several items of the same description these may be added together, for example train fares; books; and the total costs noted provided the receipts are sent to support the total claim. See Example Below OVERSEAS BANK INFORMATION: For payments to be made to a Non UK bank account all fields in Option 2 must be completed. If you are not clear about the information requested please contact your bank for the correct details to ensure that payment reaches you. Beneficiary bank account: This is the bank account that will receive the payment. This must be a personal bank account bearing your name. Intermediary/Correspondent bank account: If payment has to be made to another bank before it reaches the beneficiary bank account this is called an intermediary bank and is usually only required if your bank is unable to receive payments directly from a UK bank. Your bank will provide this information if required. BANK CHARGES: Please note that your bank may charge you for receiving international payments into your account and as a result you may receive less than the full amount you have claimed on this form. The University will pay charges made by its own bank to send the payment to you but is not liable to pay charges made by your bank or intermediary bank to you personally. If the bank details provided by you are incorrect and a payment made by the University to your bank account is rejected and the University is charged for the rejection, it reserves the right to recover such charges from any amount owed to you. EXAMPLE CLAIM FORM Purpose for Expenses Incurred (see Guidance note 3)ESRC Seminar in 91̽, October 2012 DatesDescription (see Guidance note 4)Foreign Currency Type AmountAmount GBP p01.09.12Train fares (102.40 + 95.60)1980007+08.10.2012Taxis (10.00 + 9.50)195007+08.10.2012Rutland Hotel 1 night700007+08.10.2012Tram to/from station (2.20+2.20)44007+08.10.2012Subsistence (2.85 + 10.00 + 1.70)1455Foreign currency conversion usedTotal Claim30645     FIN/EXP/NON STAFF JAN 13 PAGE   2345a|ɺyrcTBT3hEk`h9CJOJQJaJ"h9h95CJOJQJ\aJh9h9CJOJQJaJhh{CJOJQJaJ h}h{h}hKCJ(OJQJaJ(&hbwh45CJ OJQJ\^JaJ h45CJ(OJQJ\aJ(h+5)5CJ(OJQJ\aJ(h?.75CJ(OJQJ\aJ(h5CJ(OJQJ\aJ(h &h{OJQJ8jha ha CJOJQJUaJmHnHsH tH u345 |pc Z$If]Zgda $$Ifa$gda  & FZ]Zgd7#~ & Fgd+gd{Tkd[$$Ifl0(| t44 layt?.7 $Ifgd?.7 $$Ifa$gd{   \ d e y Ǹ婚m[WL<hv.Yh &5CJOJQJaJh}hAOJQJhA"ha hA5CJOJQJ\aJ:jha hd 5CJOJQJU\aJmHnHtHuhAh{CJOJQJaJhEk`h@7CJOJQJaJhEk`hN;CJOJQJaJh<h9CJOJQJaJ"h<h95CJOJQJ\aJh9CJOJQJaJhEk`h9CJOJQJaJh7#~CJOJQJaJ d_W_N_I_gd<Z]ZgdA$a$gd9gd{kd*\$$Ifl0)'  t044 l` apyta  ƬpaR74jhd hd CJOJQJUaJmHnHtHuhv.Yh|CJOJQJaJh+Fh{CJOJQJaJh+Fhq1GCJOJQJaJh+Fh{{CJOJQJaJh+Fh[CJOJQJaJhv.Yhq1GCJOJQJaJ2jhd CJOJQJUaJmHnHsH tHuhv.Yh &CJOJQJaJhv.Yh &5CJOJQJaJhEk`5CJOJQJaJh95CJOJQJaJ Ӹ_PA/"h_hW5CJOJQJ\aJh+Fh+FCJOJQJaJh+Fh %CJOJQJaJ>jhd hd 5CJOJQJU\_H aJmHnHtHuhv.Yhv.YCJOJQJaJhhq1GCJOJQJaJhhCJOJQJaJhxnCJOJQJaJ4jhd hd CJOJQJUaJmHnHtHuhv.Yhq1GCJOJQJaJh+Fhq1GCJOJQJaJhUohUoCJOJQJaJ  Z ! 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