Clone of Expenses Claim Form

Food for groups - Describe these expenses below:-

	Expense	Amount	Vat amount (leave blank if zero)
1
2
3
4
5
6
7
8
9

Other purchases - Describe these expenses below:-

	Expense	Amount	Vat amount (leave blank if zero)
1
2
3
4
5
6
7
8
9

Charity Vehicles Fuel, oil etc

	Expense	Amount	Vat amount (leave blank if zero
1
2
3
4
5

Car lease or rental for transporting members

	Expense	Amount	Vat amount (leave blank if zero
1
2
3
4
5

Printing Expenses

Mileage Expenses (not for transporting members) - List your journeys below:-

Mileage Expenses for the volunteer transporting of a member

Please upload receipts, invoices and any other evidence. (All to be dated within 30 days of this claim, unless agreed by Dementia Active)

Cancelof
Grand total to be paid in £'s & P
(Official Use) VAT to be reclaimed on this payment
Signature*

Clear
Bank account name where you wish your expenses to be paid. (If this is left blank, we will use the account we have on record). If this is your first claim please provide the information required below.
Account Name
Account Number
Sort Code (nos. only , no hyphens)