Bursary Claim Form

Bursary Claim Form
All claims are subject to the Society’s guidelines relating to its bursary fund. The Society can only pay claims for which original receipts are provided. The email confirming the bursary award must also be submitted with this claim.

N.B. THE SOCIETY CAN ONLY PAY CLAIMS SUMITTED WITHIN ONE MONTH OF THE EXPENSE BEING INCURRED AND FOR WHICH ORIGINAL RECEIPTS ARE PROVIDED
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

TownCounty

Postal / Zip Code
Phone Number*

Country CodeArea CodePhone Number
Email*
example@example.com

Bursary Details
Meeting attended*
Date(s) attended*
Value of bursary awarded (£)*
Value of bursary
Attach the email confirming your award and original receipts totaling the value of the bursary awarded*

Cancelof
I have received/will be receiving other financial support in respect of my attendance at the above meeting totalling (£)*
Other financial support
Total Bursary Claim (£)

I hereby confirm that these expenses were necessarily incurred by me in connection with the activity outlined in the bursary award letter and are not being paid by any other organisation.
I confirm the above statement is true
Submission Date
Should be Empty:

Bursary Details