Expenses Form

Please use the below form to submit an expense claim. This form can be used for travel and accommodation expenses, and for general staff expenses.

For further information about the parameters for travel expenses, please refer to this information sheet.

If you have queries, please contact us finance@brit-thoracic.org.uk

Name of Claimant *

Email address *

Address *

Name of Meeting attended / Activity undertaken / Date / Location *

Reason for Payment / Refund *

Receipts/confirmations/mileage proof - 1 *

Receipts/confirmations/mileage proof - 2

Receipts/confirmations/mileage proof - 3

Receipts/confirmations/mileage proof - 4

Receipts/confirmations/mileage proof - 5

Receipts/confirmations/mileage proof - 6

Amount Claimed *

Name of Bank

Full postal address of Bank

Bank Account Number

Sort Code

IBAN Number

BIC

SWIFT Code

ABA Number

Payment Currency

Consent for storing submitted data *

Yes, I give permission to store and process my data

Routing Number