COMMITTEE EXPENSES FORM	Finance Ref. No.

Name	Date
Address
Amount £	:
Postcode

Purpose(s):

Bank Details: Account Number	Sort Code

** (Only provide bank details if we are paying you for the first time or the details have changed) **

Email address

Claimant signature (if expenses)

Authorised by	Print name	Date

Split expenses coding as required below:

Activity Code	Nominal Code	Fund Code	Amount	£
Activity Code	Nominal Code	Fund Code	Amount	£
Activity Code	Nominal Code	Fund Code	Amount	£
Activity Code	Nominal Code	Fund Code	Amount	£

Sustainability Reporting Information – (Please fill in if applicable)

Mode of Transport (select from options)	Miles	Journey type (return/single)	From (Airport/Station/ Location)	To (Airport/Station/ Location)	If by car* Size/fuel type/ Sharing*	If by train or air, Please state class(1st/business/economy/ Unknown)

1. Please state if you were car sharing 2. Please state car size (Small <1.4L) (Medium 1.5L - 2L) (large >2.0L) or unknown 3. Fuel type (petrol/diesel/hybrid/biodiesel/unknown)