company car and car allowance policy general ... - Pilgrims Hospices

EXPENSE CLAIM FORMName:Date of Claim:Internal or home address:Mileage claimsDate ofexpenditurePurpose ofjourneyFrom To MilesHome tobasededuction *Rate Amount £Total milesTotal claimOther claimsDate ofexpenditureReason for expenditure Details of expenditure Amount £AuthorisationDeclaration:I declare that the expenses claimed are inaccordance with the approved scale of paymentset out on the Pilgrims Hospices expenses policy.This claim is not in excess of the actual costsincurred.Certification:I certify that the expenses claimed werenecessarily incurred on Pilgrims Hospice businessand comply with the Hospice Expenses policy. Iconfirm original copies of receipts are attachedand are legitimate.SignatureClaimant signature Authorised by (print) Authorised by (signature)Please attach all original receipts as appropriate and send this form to the Accounts Department inCanterbury. * when working further away from your normal base, please ensure you deduct your normalcommutable travel miles.8