HOME-START SURREY HEATH

Volunteer’s monthly expense claim form

 

This form is to be completed by the volunteer and returned to the Home-Start office each month.

 

I incurred the following expenses during my work as a Home-Start volunteer:

Full Name:

Address:

 

 

Month:

Year:

Date

Journey from

Journey to

Purpose of journey

Mileage

Fares

Tele Calls1

Other expenses2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                                                            TOTAL

 

 

 

 

 

NOTES:

  1. If you need to make telephone calls in connection with your FAMILY visits, please try and keep them at the cheapest rate

  2. Please discuss with the organiser/co-ordinator, beforehand if possible, any other miscellaneous expenses.

  3. Submit claim by the middle of the following month.

  4. Expenses are paid at 37p per mile from 1/11/03 and 20p per 5 minute phone call.

  

 

 

 

 

 

 

 

 

 

£

If your claims includes car mileage please complete:

 

* I certify I hold a full driving licence and have adequate insurance cover, the car

is roadworthy, taxed and has a current MOT certificate:

 

SIGNED: ____________________________________

 

SIGNED: …………………………………………..............………  Date: …………...................……………

 

If you wish to donate your expenses to Home-Start please tick this box         o

 

Thank you.