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Work Based Learning Travel Expenses Claim Form 2010-11

Name: __________________________________ Placement Provider: _________________________

Address (whilst on placement): Address:


........................................................................................ ........................................................................................
........................................................................................ ........................................................................................
Postcode: ....................................................................... Postcode: ........................................................................

Deadline for submission to the Work Based Learning Office: 22nd June 2011
Forms should not be submitted to tutors or inside the WBL report
Claims submitted after the deadline will not be considered

• We will only reimburse the cost of travel to and from your placement minus your normal University travel costs for a 5-
week period.
• To make a successful claim you must complete and return this form. If travelling by car you must include a multimap
(www.multimap.co.uk) or equivalent route planner of your route, clearly stating the mileage. If using public transport, you
must include your original bus/train transport tickets (in date order) OR ticket receipts with your claim.
• Your placement timesheet will be used to verify the days you attended the placement – please ensure that your placement
provider returns this document to Work Based Learning by the deadline.
• The University is able to subsidise travel expenses up to a 30 mile radius (i.e. a 60 mile round-trip) from your
accommodation whilst on placement to your workplace, per day up to a maximum of 25 days and up to the value of £200.
• Claims will only be considered on completion of the placement, submission of the WBL assessment and the documentation
as listed above.

SECTION 1: Placement Travel Expenses


A B C
Days on Travel costs Total for placement
placement
Public Transport [please provide details overleaf (Section 4)]
______ days £
Total of receipts £ _________
Car Mileage (round-trip maximum 60 miles)
______ days £
_______ miles per day @ _____* per mile = Daily total £ _________

______ days Walk / Cycle / Get a lift / Other £ 0.00

TOTAL D £

SECTION 2: Usual University Travel Expenses


E F G H
Days travel per Daily travel costs Weekly total 5 weeks total
week (E x F) (G x 5)

______ days Public Transport £ _________ per day £ £

Car Mileage (round-trip maximum 60 miles)


______ days £ £
_______ miles @ 10p per mile = £ _________

______ days Walk / Cycle / Get a lift / Other N/A £ 0.00

TOTAL I £

SECTION 3: Total Claim


Placement Travel Expenses (D) minus Usual University Travel Expenses (I) £

* If you use your own car to travel to and from your placement we will pay 10p per mile . If you will be taking WBL passengers add
2p per mile per passenger. Please list the names of your passenger(s) below:

_____________________________ _____________________________ _____________________________

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Please turn over, complete the evidence and Bank/Building Society Details section and sign
SECTION 4: Evidence

I confirm that I have attached a multimap or equivalent route planner of my route illustrating the mileage
I confirm that I have attached and listed below each ticket I purchased and wish to claim for (public transport only)
I confirm I will encourage my placement provider to return the placement timesheet to substantiate this claim

Ticket Dates Journey (From . . . To . . .) Cost


(Continue on a separate sheet if necessary)

Total

Total Claim for Mileage: £ _________________________

Total Claim for Public Transport: £ _________________________

I confirm that the information I have provided in this form is correct to the best of my knowledge and that I have read and
understood the Terms & Conditions For Payment of Travel Expenses (back page).

Signature of Student: _________________________ Date: ____________________

Checked by WBL Office: _________________________ Date: ____________________

Certified correct for payment as per University Regulations Department account £ p


DEPARTMENT AUTHORISED OFFICER to be debited

FLL - 23604085
……………………………………………………………. ………………… …..:……

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SECTION 5: Bank/Building Society Details

Payment will be made by electronic transfer to your bank or building society account:
• The details requested below are for use by the University of Chester Finance Office.
• Travel Expenses Claims will be processed after the WBL Subject Assessment Board in June 2011. Please note that due
to the nature of the travel expenses claims and the workload of the WBL Office and Finance Office at the end of the
academic year, successful claims will be paid into your bank account (subject to the Terms & Conditions for Payment of
st
Travel Expenses Claims) by the 31 August 2011.
• Incorrectly completed forms or queries on claims may be subject to a delay in processing.
• If the details are incorrect, the University of Chester Finance Office may issue a cheque as an alternative method of
payment. Please ensure you enter the address below where you wish the cheque to be sent. Please note that the
claim may take up to two months to process so ensure that you give details of the most appropriate address (e.g.
home address rather than term time address).

Please complete in BLOCK CAPITALS

Student Name:

Address (see note above):

Mobile No: Postcode:


Bank/Building Society Name:

Branch Address:

Account Holder’s Name


(as printed on cheque/card):
Sort Code (6 digits):

Account No (8 or 9 digits):

Building Society Issue No


(If applicable):

Finally . . .
Please read the Terms & Conditions for Payment of Travel Expenses Claims overleaf before submitting your form and
please ensure that you keep a copy of your form and tickets/receipts/multimap (or equivalent route planner) for your
personal records. Please remind your placement provider to return your timesheet to the WBL Office.

Please turn over to read the Terms & Conditions for Payment of Travel Expenses Claims
then SIGN the form on page 2

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SECTION 6: Terms & Conditions for Payment of Travel Expenses Claims

1. No payment is made for:


a. Travel expenses
• beyond the 30 mile radius (ie. 60 mile round-trip)
• above the maximum value of £200
• in excess of 25 days;
b. Taxi fares;
c. Claims other than for travel (e.g. parking fees, road/tunnel tolls, accommodation, etc.);
d. Travel between term-time residence and accommodation during placement;
e. Travel on placement provider’s business;
f. Meals, except in the case of students who have pre-paid for University meals. (Consult WBL Office if you
have a claim.)

2. It is University policy that students are only entitled to claim for travel costs which are in addition to the normal
cost of travel between the term-time residence and University.

3. Claims will normally be considered for up to a maximum of 25 days. Work Timesheets must be submitted by the
placement provider to substantiate all claims. Please note any days you have not worked e.g. Bank Holidays,
School Holidays or absences, should not be included in the claim.

4. Claims can be made for travel to your place of work from your address whilst on placement, up to a radius of 30
miles, only where your placement has been approved by Work Based Learning. Where placements exceed this
distance, only the first 30 miles of each journey will be considered.

5. All tickets or receipts for public transport must be attached to the Travel Claim, as proof of purchase, for each
journey claimed, reimbursement cannot be made for missing receipts/tickets. Please note that some train
ticket barriers retain tickets once you have passed through them.

6. Where a student chooses to use a car for travel to and from their placement, it is the student’s responsibility to
ensure that they have appropriate car insurance, tax etc. and that the vehicle is in roadworthy condition.

7. Car travel expenses claims will be paid at a rate of 10p per mile and an additional 2p per mile per passenger
(WBL student passengers only – please list names on this form). Mileage rates correct at time of printing.

8. The inclusion of an item on Travel Claim Form does not in itself guarantee payment for that item.

9. The University Finance Office will pay approved expense claims electronically to your Bank or Building Society
account. Please note due to the heavy workload of the WBL and Finance Office at this time of year, claims will
be paid into your bank account (subject to these Terms & Conditions for Payment of Travel Expenses Claims) by
the 31st August 2011.

10. Claims will only be considered on completion of the placement and submission of the WBL assessment.

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11. Claims submitted after the deadline of 22 June 2011 will not be considered.