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HKD 354/1
TION SECTION C
Declaration I certify that:
1 I made the journeys detailed in this claim.
2. The expenses shown 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 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.
Travel and Subsistence Claims Form
All secti of this form should be completed.
SECTION A
Please complete in BLOCK LETTERS
Surname
Forename(s).
Full Private Address.
RICLETTS
PETER
Title (Mr/Mrs/Miss/Ms) .....
Grade
Signature
*delete as appropriate
Grebelt
Date
29/
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.
ичого
53 GILPIN AVENUS
(NDOW SW14 8Q x
Division/Branch/Project Number
Official Duty Station.
Temporary/Detached Duty Station
Full Official Address.
FCO
Postcode.
More have Dea
MKD
WH307
MR
Signature
Date
24/11191
(Authorising officer)
N J Co X
DS 5(s)
Name
Rank
(BLOCK LETTERS).
For Departments use only
Date received
Examined and Passed
initials date.........................................
Date paid
If payment is made by cash the following receipt must be signed Received the sum of
£
Amount (in words)
Signed
Date
Tel. number.
270 2647
1. Payment of this claim should be made to my *BANK/QEEIGE/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 71 43 8794
Name of Bank
Address of Bank
FIRST
DIRECT
MILLSHAW PARK CHANE
LEEDS LSI OLT
3. A payment advice for sums paid directly to my bank should be sent to my
*OFFICE/PRIVATE ADDRESS.
* Delete as appropriate
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Private notes are available after approval.