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Expense Claim Form
Your Name
(*)
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Phone Number
(*)
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Email
(*)
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Which Parish/Organisation are you with?
(*)
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Reason for Claim including dates and purpose of any travel
(*)
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Your Bank Account Number is:
(*)
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Format: 12 3456 123456 000
The Bank Account Name is:
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Stationery, Postage, Copying
How much are you claiming?
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Phone and Tolls
How much are you claiming?
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Other - Please Specify
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How much are you claiming?
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To claim expenses other than travel expenses you will need to submit receipts.
Would you like to upload your receipts now?
No
Yes
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Upload Receipts
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Use of Private Motor Vehicle
How many kilometres travelled
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Your Total Claim is:
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Payment will normally be made about the 20th of the month following authorisation of this claim form
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