Expenses Claim Form

Operations - HN & VQ Expense Form v2.0 July 2019  

1. Claimant Details Name NI Number Address Postcode 2. Claim Details

Type of Work If Remote activity carried out detail total hours spent: If Visit activity carried out complete the following: Departure Date Total hours spent travelling to destination Visit Date Total hours spent at the centre Return Date Total hours spent travelling home Centre Name/ Event Venue Centre Number Location of Centre/Venue Verification Group Number Event ID/Prior Verification Reference (if applicable) Additional Comments (please use this space to provide any additional details that are relevant to your claim for this activity; e.g. if an alternative site other than the main centre address has been visited, if you have undertaken more than one activity on the same day, reason for using taxi’s)

3. Expenses (all itemised receipts must be included)

Transport £ Car Miles Subsistence £ Other necessary expenses (detail) £ Total £

4. Declaration

I confirm that I carried out this activity in my own time my employer’s time If activity was carried out in employer’s time, please ask your employer to complete below: Name of Main Employer Main Employer’s Signature Date Release from Employment Half Day Full Day Claimant’s Declaration - I hereby certify that the expenses above have been actually and necessarily incurred solely by me on SQA 

business and that the claim in every way conforms with current allowance rates and other regulations as defined by SQA.  Claims in excess 

of current allowances must have prior authorisation and be submitted with supporting documentation. Claimant’s Signature Date (electronic or photocopied signature will not be accepted) SQA Use Only Fees £ Expenses £ APS Schedule Reference Entered By Date Authorised By Date Report Received/On Register Payment Recorded Release Payment