FORM C
Tel: 01903 285024
EXPENSES CLAIM FORM
Tel: 01243 788122 ext 2731
(ALL CONSULTANTS &
NON TRAINING GRADE DOCTORS)
Please complete in BLOCK CAPITALS and submit within 6 weeks of event attended.
Claims received after the 15th of each month will not be repaid until the following month
SECTION 1 – PERSONAL DETAILS
Surname
Forename
Department
Grade & Specialty
SECTION 2 – EVENT DETAILS
Event Title
Event date(s)
You must have submitted Form A (Application for study leave) to be entitled to claim a reimbursement
SECTION 3 – CLAIM DETAILS
I wish to claim the following expenses:
£
Event fee:
Travel:
£
Public Transport
Private Car – total no. miles:................
(@ 25p per mile)
Subsistence:
Accommodation – total no. nights: ...............
(max £60 per night)
Meals:
(£5 lunch, £15 evening meal)
£
£
£
£
Total expenses claimed
Receipts must be submitted for all claims (except mileage)
SECTION 4 – DECLARATION
Claimee Signature*
*I agree that I have read and submitted this application in accordance with the study leave guidelines
SECTION 6 – AUTHORISATION (for PGME use only)
Approved by:
Date:
Training grade doctor cost code:
Y771
Subjective Course Fees:
7300
Amount approved:
£
Subjective Expenses:
7270
Amount approved:
£
PLEASE RETURN COMPLETED FORMS TO:
Review date: June 2016
SAM VAUGHAN, MEDICAL EDUCATION
MANAGER, CMEC/WHEC OFFICES
See reverse for guidance
Tel: 01903 285024
Claim Request Guidance
Tel: 01243 788122 ext 2731
All leave should be requested via CRMS prior to claiming expenses. CRMS does NOT approve the
expenses element of your leave. CRMS approves the activity and absence only.
Claim requests must be submitted within 6 weeks of the event attended
Claim requests submitted after 6 weeks will not be accepted
Claim requests will not be paid without proof of payment and proof of attendance.
It is the doctor’s responsibility to ensure all necessary paperwork is present and correct.
Reimbursement for event fees will not be paid in advance or directly to the event organiser.
All fees must be paid by the doctor prior to the event.
Claim requests must be submitted by the 15th of each month to meet the payroll cut off for
reimbursement in the following months salary. Claims received after this date will be paid the
following month*
The study leave process does not link with CRMS.
Claims must be sent to PGME for processing.
Entitlement:
Consultants & Non-Training Grades

Eligible for up to 30 days over 3years**

Budget is £600 per year (1st April to 31st March inclusive)**

Budget cannot be carried over into the next financial year
End of the financial year - 31st March
Please note, during March claims will be processed using expense form and receipts only. However
proof of attendance is required after the event. All claims with receipts should be submitted to PGME
by the end of the 3rd week in March in order to ensure budget is taken from the current financial year.
Any claims received after the 3rd week in March may miss the financial cut off period and be taken from
the new financial year/study budget. There is no “roll-over” of funding for study leave.
For details about individual study leave allowance and funding please contact:
Worthing
- Jane Snadden
- ext 85024
Chichester
- Davina Desborough
- ext 2731
* These dates are a guide only; PGME cannot not guarantee when payment will be made
** correct at time of publication