Mileage - PA driving with or on behalf of a Service User

Mileage - PA driving with or on behalf of a Service User
This mileage claim form is specifically for journeys made while carrying a service user in your own car or for any trips you may take on behalf of the service user (shopping, running an errand etc.) during your working hours with the service user.

A specific Driving Service Agreement is required in advance of making claims for these journeys and needs to be signed by both the PA and the servcie user.

Claims are to be made monthly

It is essential that you claim every month as requested. Late claims will be deemed inelligible and will not be paid
If you use your car to run errands on behalf of a service user (shopping, pharmacy run etc.) & wish to make a mileage claim - do you have a driving service agreement set up for this?*

YesNo
If you drive a service user in your own car and wish to claim mileage for these journeys - do you have a driving service agreement in place for this arrangement?*

YesNo
If you do not have a driving service agreement for either driving a service user in your car or for driving on behalf of a service user - you need to contact a member of the office staff to set this up.

You cannot claim for these mileage journeys until this is complete.

Please email admin@corkcil.ie to organise this.
PA Name*

First NameLast Name
Service User Name*

First NameLast Name
SU Mileage*
Total KMs
I confirm that this is an accurate claim. I am the owner of the vehicle and have appropriate insurance, road tax and valid NCT

I confirm
Date*

DayMonthYear
Date
Please verify that you are human*
Please Note

In completing and submitting this form you are making a claim for payment in respect of mileage. You must ensure that your claim is accurate. When making a claim for mileage you must have a full licence, NCT if required, appropriate insurance and have indenified Cork Centre for Independent Living. Vehicle insurance is at your own cost. Payment will be made directly into your bank account through the payroll system.
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