United Dioceses of Cork, Cloyne and Ross

Employees and Officers of Charities in Cork, Cloyne and Ross

Expenses Claim

This form should include claims in respect of one calendar month only. - Forms should be submitted as soon as possible after the end of the month in which the ministry was undertaken. - Forms should be submitted and claims made no later than before the end of the calendar month following the month in which the expenses were incurred. - Incomplete forms will not be processed and expenses will not be paid. - Claims for small amounts will be accumulated and paid quarterly.

Your Name *

Body from whom amount is being claimed *

Year *

Month in respect of which Claim is being made *

Travel Claim

Travel from 'where' to 'where' *

Name of event or purpose of travel: *

Date of event or travel *

Kilometres travelled on this date only: *

Amount claimed for travel for this event or purpose (rate is 41 cent per kilometre) *

Subsistence Claim
(Receipts of scans of receipts should be sent separately)

Is there a claim also for subsistence or overnight costs? *

Yes

If 'Yes' has the bishop or your
line manager approved this expense in advance of expenditure

Yes

Amount claimed for subsistence:

Please upload a scan of receipt for subsistence

Amount claimed for overnight accommodation:

Please upload a scan of receipt for overnight accommodation

Other Claims
(Receipts or scans of receipts should be sent separately)

Is there a claim also for something else other than travel,
accommodation or subsistence? *

Yes

Type of expense incurred

Details of expense incurred

Expense authorised by:

If 'other' give details

Total Amount claimed *

Your Email Contact for Queries *

Your mobile number for form queries: *

Date of Claim *

I have read and agree that my data may be processed by the Diocesan Council in accordance with the Data Privacy Policy: *

* = Input is required

United Dioceses of Cork, Cloyne and Ross

Employees and Officers of Charities in Cork, Cloyne and Ross Expenses Claim

Travel Claim

Subsistence Claim (Receipts of scans of receipts should be sent separately)

Other Claims (Receipts or scans of receipts should be sent separately)

Employees and Officers of Charities in Cork, Cloyne and Ross

Expenses Claim

Subsistence Claim
(Receipts of scans of receipts should be sent separately)

Other Claims
(Receipts or scans of receipts should be sent separately)