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
Name: Checked By:
Engine Size (cc): Verified By:
Car Reg Number: Date:
Travel From Travel To
Rate per Mile
Method of Travel
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.
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.
Description of Duties
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.