Fillable Selby District Council - Members' Travel and Subsistence (Selby District Council)

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Selby District Council - Members' Travel and Subsistence (Selby District Council)

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Selby District Council - Members' Travel and Subsistence Claim Form
Please ensure that you have attached the relevant receipts for any claims above. When complete, please return the form to
Democratic Services.
Name: Checked By:
Engine Size (cc): Verified By:
Car Reg Number: Date:
Payroll Month:
Total Paid:
Travel From Travel To
No of
Miles
Rate per Mile
(£) (Office Use
Only)
Amount
Claimed (£)
(Office Use
Only)
Parking Fee
(£)
Method of Travel
Claim (£)
I DECLARE THAT:
1) I have necessarily incurred expenditure on travelling and subsistence for the purpose of enabling me to perform approved duties as a Member of Selby District Council.
Signature: Date:
Subsistence (£)
Journey By Car
2) Where reclaiming costs, I have actually paid the amounts being claimed above.
3) The amounts claimed are in accordance with the Selby District Council Members' Allowances Scheme.
Date
Time of
Meeting/Event
Description of Duties
TOTAL CLAIMED:
5) I have attached all the necessary receipts associated with the claim.
6) All of the information supplied on this document is correct.
4) Except as shown above, I have not made, and will not make, any claim to any other body for travelling or subsistence expenses in connection with the above duties.
For Office Use Only
Selby District Council - Members' Travel and Subsistence Claim Form
Please ensure that you have attached the relevant receipts for any claims above. When complete, please return the form to
Democratic Services.
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Selby District Council - Members' Travel and Subsistence (Selby District Council)

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Completed 8 December 2020

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