Salary Replacement Costs Turnaround Document
Due for the Quarter
Ended :
To agree amounts due please complete this form and return to the following email address:
[email protected]
Your Organisation Entity
Code :
Your Organisation Name
:
Paying Organisation
Entity Code :
T73
Paying Organisation
Name :
Health Education Yorkshire and Humber
Total Due for this quarter
(as per attached
schedule)
(£)
Total Due for this quarter
(as per trust)
(£)
Total amount disputed
(£)
Please enter details of any employees on the attached Disputes sheet - whose details you think are incorrect
- who you think should be added to our database
- who you think should not be receiving salary backfill
- whose status may have changed since the previous quarterly payments
Please note failure to enter details into compulsory fields marked red will likely result in delayed payment for these disputes.
Any subsequent validated amendments to the statements will be included on the next quarterly statement/payment.
The total amount agreed will be paid on
Signature :
Date :
Print Name :
Job Title :
Contact Tel :
Contact Fax :
E-mail Address :