EXPENSE CLAIM FORM

EMPLOYEE _____________________________________________________________________________________________________________________

HOME ADDRESS _______________________________________________________________________________________________________________

LOCATION OF TEMPORARY WORKPLACE/SITE ADDRESS: ______________________________________________________________________

METHOD OF TRANSPORT ______________________________________________________________________________________________________

VEHICLE MAKE, MODEL, CC AND REG. NO ______________________________________________________________________________________

SUBSISTENCE
(food and drink) non receipted but receipts must be retained.

You may claim a 5 meal allowance rate if you have been away from home for over 5 hours and a 10 meal allowance rate if
you have been away from home for over 10 hours. If you qualify for the 5 or 10 rate and you arrive home later than 8pm,
you may claim an additional 10.

If you have been away from home for over 15 hours and you arrive home later than 8pm then you may claim a 15 meal
allowance rate.

TIME YOU TIME YOU

DATE LEFT HOME ARRIVED HOME SUBSISTENCE RATE () TOTAL ()

TOTAL:

MILEAGE
non receipted

Car = 45p per mile for the rst 10,000 miles in a tax year (25p thereafter) Motorcycle = 24p per mile, Cycle = 20p per mile

FROM TO TOTAL CLAIM

DATE (ENTER POSTCODE) (ENTER POSTCODE) TOTAL MILES PER DAY PER DAY ()

TOTAL:

Continues Overleaf
NATIONWIDE CONTRACTOR SOLUTIONS LTD (CREDIPAY)
Leigh House, Weald Rd, Brentwood, Essex, CM14 4SX Tel. 0203 096 7266 Fax. 01708 373 564 Registration No. 08040747 www.credipay.co.uk Email info@credipay.co.uk
EXPENSE CLAIM FORM

ADDITIONAL EXPENSES
receipts needed

Train, bus, congestion charge, parking costs, tolls, workwear etc.

DATE DESCRIPTION TOTAL

TOTAL:

DECLARATION

I conrm that I am responsible for the accuracy of each claim and conrm that this claim is correct and complete.

I conrm that this claim form constitutes my claim for expenses incurred in the performance of my duties of employment
with Credipay Contractor Services.

I conrm that it is my intention to move to another assignment after completing my current assignment.

I conrm that my current assignment at this workplace location will not extend beyond 24 months.

I conrm that the travel and actual costs associated with subsistence expenses have been incurred as a consequence of
the necessary attendance at a temporary workplace in the performance of my duties.

I have attached appropriate receipts for all expenses claimed except mileage payments.

I have retained my receipts to support my subsistence claims and will provide them to Credipay Contractor Solutions if I
am subject to an expense audit.

I have read and understood the expenses policy to which this claim relates.

EMPLOYEE SIGNATURE: DATE:

Please make sure all expense claim forms are completed and returned by Tuesday 12:00 (midday). Any forms that miss the
deadline will be oset the following week.

NATIONWIDE CONTRACTOR SOLUTIONS LTD (CREDIPAY)

Leigh House, Weald Rd, Brentwood, Essex, CM14 4SX Tel. 0203 096 7266 Fax. 01708 373 564 Registration No. 08040747 www.credipay.co.uk Email info@credipay.co.uk