CEIP
LOND
OCTION
CTION C
Declaration I certify that:
R
1. I made the journeys detailed in this claim.
2. The expenses own have been actually and necessarily incurred by me on
the Public Service.
3. The allowances charged comply with the Rules of this Department.
4. (for motor mileage claimants only) I hold a valid driving licence and my motor
insurance policy covers the use of the vehicle on official business.
5. "I do/do not hold a season ticket for the return journey between my
home and my permanent station/duty station.
6. "I do/do not have a standing/temporary imprest.
Signature
"delete as appropriate
Date 21.2.91
Sent #21/2 pa sent
Travel and Subsistence Claims Form
All sections of this form should be completed.
SECTION A
Please complete in BLOCK LETTERS
Surname
Forename(s)
PAUL
ALAN RODERICK
BLOSSOM
Full Private Address.
14
SOUTH CROYDON.
SURREY
MR
Title (Mr/Mrs/Miss/Ms).
Grade
4
CLOSE
Postcode (R2 7EZ
HKD/FCO
Approval - please check Section B before approving this claim
I confirm that, to the best of my knowledge and belief, the facts given in this claim are correct, that the expenses were actually and necessarily incurred on official business in the most economical manner, and that the allowances charged comply with the rules of this department.
Signature
Racing H. Hard
фил
(Authorising officer)
Name R. M. MARE DIN
(BLOCK LETTERS).
For Departments use only
Date received
mined and Passed
itials and date.
Date
21/2/91
55
Rank
If payment is made by cash the following receipt must be signed
Received the sum of
£
Amount (in words)
Signed
Division/Branch/Project Number. FCO
Official Duty Station.
Temporary/Detached Duty Station.
Full Official Address. ROOM
HONG KONG DEPT.
WH307 A FCO
Tel. number 071
270 2647
FAA KING CHARLES ST.
1. Payment of this claim should be made to my *BANK/OFFICE/PRIVATE
ADDRESS
2. If payment is to be made direct to your Bank please give below your account number and both the name and full address of your bank
Account number
0308027
Name of Bank LLOYDS
Address of Bank
SOUTHEND
CROYDON
CRO IYA
3. A payment advice for sums paid directly to my bank should be sent to my
*OFFICE/PRIVATE ADDRESS.
Date paid
Not
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Private notes are available after approval.