Claim Form

Personal Details (Please use BLOCK CAPITALS)

Home Address (to be completed in all cases)

Title

Mr, Mrs, Miss, Ms, Other

Surname

Full First Name(s)

HASSRA Region

HASSRA Membership Number

Staff Number or "Retired"

Postcode

Name of Office Location

Bank Details

E Mail Address (if not DWP)

Name of Bank

Contact Telephone Number

Sort Code

Payee (if not the claimant)

Account Number

Account Name

Please see the attached guidance notes before completing this document.

Reason for claim

Date(s)

Event & Venue (full address)

Official Passengers

Name, location and pick up

point of official passengers

Details of Journey (please include each section of your journey, including where you pick up passengers)

Date

From*

To*

Start

End

Method of

Actual

Passenger

Actual

Other

Explanations

Time

Transport

Mileage

miles

fares paid

expenses

Totals

Total Claimed

Rate per Mile see note 7

* State "Home" or "Office" if appropriate

Totals

£0.00

Declaration

I declare that .....

I am a current member of HASSRA

I have travelled and/or incurred the expenses described above solely in connection with the event(s) specified on this form

I am not eligible to receive these expenses (in part or full) from any other body or organisation

Signed:

Any passenger(s) who travelled with me qualify for reimbursement under HASSRA rules

Date:

NB Mileage will be checked by AutoRoute to confirm figures stated are correct.

(Type your name if submitting form electronically)

If you have receipts to support your claim, you must print the form and submit it with your receipts attached.

If you do not have any receipts, you can submit the form electronically by e-mail. Click below to submit the form to your Regional HASSRA office.

FOR OFFICIAL USE ONLY - to be completed in all cases

Payment Authorisation

Payment details

Notes

I certify that these expenses were incurred on appropriate HASSRA business

Mileage Checked: YES / NO (delete as appropriate)

Amount Paid: £

Amount Authorised for Payment: £

by : - (delete as appropriate)

Category of Budget Expenditure:

Cheque - Number:

Tracking System Line Number:

BACS - Number:

Signed:

Position:

RBP / RA

(delete as appropriate)

Position:

RFM / RFA

(delete as appropriate)

Date:

Guidance Notes


		HASSRA EXPENSES POLICY
		AND GUIDANCE NOTES FOR COMPLETION OF CLAIM FORM

	1	VALUE FOR MONEY
		HASSRA aims to offer a value for money service that includes the payment of expenses. Members and Competitors are reminded that it is members money that pays for travel expenses therefore the most economical form of transport must always be used.

	2	WHAT WE EXPECT FROM YOU
		Expense claims should be fully completed and submitted for payment with adequate evidence of expenditure. Failure to provide the necessary evidence may delay your claim or even lead to it being rejected. Where insufficient space on the claim form prevents a full and clear explanation, a separate sheet should be attached to detail particularly complicated or lengthy claims. If, after reading the following notes, you remain unsure about the completion of your expense claim form please contact your HASSRA Regional Business Partner, Regional Finance Manager, National Team Manager or event organiser for advice. All claims should be submitted no later than 10 working days after the event.

	3	WHAT YOU CAN EXPECT FROM US
		Upon receipt of a fully completed claim with all supporting documentation/evidence, we will issue payment within 15 working days of receipt. Any claims found to be fraudulent will result in appropriate disciplinary procedures being taken.

	4	METHOD OF PAYMENT
		Where possible, payments will be issued by BACS directly into your bank account. Otherwise, payment will be made by cheque. Under no circumstances will payment be made on the day of the competition or by cash.

	5	TRAVEL BY PUBLIC TRANSPORT
		The cheapest method available must be used. Saver or other discounted tickets are the norm and only in exceptional circumstances will 'Walk on' standard tickets be refunded. Under no circumstances will the cost of first class travel be reimbursed.

	6	TRAVEL BY CAR
		When travelling by car you must make every effort to share with team mates/fellow competitors where possible. Your HASSRA Regional Business Partner, National Team Manager, or the event organiser will advise of other local travellers if asked. Competitors should note that payment for travel by car is restricted to a maximum of 400 miles per return journey unless you are accompanied by a passenger(s) who would also be eligible to claim for HASSRA expenses. Competitors attending certain National Championships may exceed the 400 mile limit if they have to carry heavy/cumbersome equipment E.g. Angling, Bowls, Golf, Music (instrumental), Small Bore Rifle and Tenpin Bowling. It should be noted that a percentage of claims will be subject to a check on mileage and adjusted if necessary.

	7	MILEAGE RATES
		National Events/Championships
		Car & Driver only - 25p per mile 1st passenger - 5p per mile (mileage not payable for additional passengers)

		Regional Events/Championships
		Check with your Regional HASSRA Office or Event Organiser for current rates

		Input the appropriate Rate per Mile on the form using decimal format (E.g. 25p per mile = 0.25).

	8	TRAVEL BY TAXI
		If, exceptionally, it is necessary to hire a taxi, a receipt should be obtained and submitted with the claim. In these circumstances, every effort should be made to share with fellow competitors/members. Taxis from or to home will only be paid in exceptional circumstances (e.g. very early/late finish, travelling with heavy or cumbersome equipment). Claims are subject to HASSRA approval and any claim without the relevant tickets/receipts will be rejected.

	9	TRAVEL BY AIR or HIRE VEHICLE
		In all cases, permission for travel by air or by hire vehicle must be first obtained from your HASSRA Regional Business Partner or National Team Manager.

	10	HASSRA MEAL ALLOWANCE(S)
		HASSRA Meal Allowances are only payable when HASSRA, or the event organisers, have not provided for all meals consistent with the itinerary of the event or where the length of a member’s journey to/from the venue dictates that the purchase of a meal is necessary. The rates payable are:-

		National Events/Championships
		Over 5 hours £5.00 Over 10 hours £12.00

		Regional Events/Championships
		Check with your Regional HASSRA Office or Event Organiser for current rates

		Where a Meal Allowance is claimed, the amount should be shown in the ‘Other expenses’ column of section 6 of the claim form. The time of leaving home or office and return to home or office must be entered in the relevant columns of section 6.

	11	ANY OTHER EXPENSES
		Where any other expense is claimed, the amount should be shown in the ‘Other expenses’ column of section 6 of the claim form. Full details should be given in the 'Explanations' column of the claim form.

	12	WHERE TO SEND THE COMPLETED FORM
		Send the completed claim form to your HASSRA Regional Office.
		If you have no receipts to submit with your claim, you may submit the form by e-mail.
		If you have receipts to attach, you must submit the claim by hard copy.
		The address and contact details of your Regional HASSRA Office can be found on the HASSRA Website.

National Pages

Claim Form

Guidance Notes

Regional Pages