Mileage & Expenses Claim Form

Mileage & Expenses Claim Form
This claim for is specifically for claiming mileage while travelling for your work (from SU to SU etc.)

If you wish to claim for journeys made while carrying a service user in your car or journeys made on behalf of a service user (shopping, running errands etc.) please click here to open that claim form and submit those details.

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

Enter the SU's Full Name in both the 'From' & 'To' columns

Have you read the Driving for Work Policy & Mileage & Allowable Expenses Policies?
Name*

First NameLast Name
Mileage Claim*
Total KMs
Expenses
Total Expenses €
Upload Expense Receipts

Cancelof
I confirm that this is an accurate claim. I am the owner of the vehicle and have appropriate insurance, road tax and valid NCT
Date*

DayMonthYear
Date
Please Note

In completing and submitting this form you are making a claim for payment in respect of mileage or other agreed expenses. 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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