External Panel Member Fee

1
External Panel Member Fee Expense Claim Form
Please use BLOCK CAPITALS
Full Name
Address
Postcode
NI Number
Tel No
Account Number
Bank Sort Code
Date of interview
School/Service Team

p
Item
Specify details attach receipts
Rail Travel 2nd Class
Car Travel _at_25p/mile Up to cost of 2nd class rail
return
Include number of miles. Receipts not necessary.
Fee

96
15
Hotel Expenses
Meals
Total Expenses
I certify that I have incurred the above expenses
in connection with the interview indicated and I
am entitled to the payment due
Signed
Date
Completed forms should be returned to the Human
Resources, Kingsway House, Hatton Garden,
Liverpool L3 2AJ.
Authorised Signature
Date
Designation
10 326101 3403 K0002 HADMO1
Jan 2007
Financial Code