Staff Mileage Claim Form |

Name*

Email*

Month*

Home*

Travel Base*

This is the geographical centre of your teaching and is assigned by your line manager at the beginning of each year.

Mode of Transport

Select ANY that apply

Car
Bicycle
Public Transport

Mileage Details*

For car or cycle miles, please complete one line per day of travel claimed. In Journey Details please include your start point (base or home), each destination and your end point (base or home). It is possible to copy journey details from previous lines on the form.

Date	Journey Details	Miles Claimed

Public Transport

Date	Transport Type	Amount Claimed

Have you changed car details since your last claim?

Make/Model of Car

Engine CC (petrol/diesel)*

Reg No.*

I Certify...*

...that the details provided in this form are correct

I Further Certify...*

...that I have current motor insurance which permits the use of the vehicle for business and that I hold a current valid driving license.