BACS Payment Requisition Form

Name of LED staff member requesting payment*

First NameLast Name

Your Email*

example@example.com

Your Site*

Area of business

State the reason for payment request*

Value of BACS payment required (£)*

Name on Bank Account (to whom the money is being paid to)*

Account Number*

Sort Code*

We need a breakdown of the items you are claiming - please complete one transaction line for each transaction, ensuring you allocate the correct accounting code and VAT treatment as per the receipt. The value of the transaction lines should match the value of the BACS payment requested above. If you are unsure which accounting code should be used, then please check with your line manager or refer to the codes via the link below.

List of accounting codes

Nominal Code*

Department Code*

Cost Centre Code*

Project Code

VAT*

YesNo

Transaction Value (Calculated)*

Net Value*

VAT Value*

Additional lines required?*

YesNo

Nominal Code*

Department Code*

Cost Centre Code*

Project Code

VAT*

YesNo

Transaction Value (Calculated)*

Net Value*

VAT Value*

Additional lines required?*

YesNo

Nominal Code*

Department Code*

Cost Centre Code*

Project Code

VAT*

YesNo

Transaction Value (Calculated)*

Net Value*

VAT Value*

Additional lines required?*

YesNo

Nominal Code*

Department Code*

Cost Centre Code*

Project Code

VAT*

YesNo

Transaction Value (Calculated)*

Net Value*

VAT Value*

Please look at the invoice and confirm it is addressed to LED Community Leisure/Enterprises and clearly showing your site details? (any invoices incorrectly addressed or made out to LED Leisure Management will be rejected and you will need to resubmit a new BACS requisition form)

File Upload - We cannot accept claims without the correct VAT receipt or backup*

Approving Manager's Name*

First NameLast Name

Email*

example@example.com

Date*

Date

Error Check

If this figure is not equal to the value of your claim then you have not completed the correct number or value of transactions to meet the BACS payment required. Please check again! Your claim cannot proceed until all errors are corrected.

I confirm that the information I have submitted in this form is true & correct. I understand that any wilful dishonesty will be classed as misconduct and result in disciplinary action.

You cannot approve your own request.

Please send to your line manager for approval.

Signature