Travel and Expenses Services

Non Standard Expense Payment to Employee – Ad Hoc

Please complete all fields. This form should only be used for non-Concur expenses and when
issued to you by Financial Management. (Do not use this form for Visas)

Part 1 – Claimant

School/Department MECHANICAL ENGINEERING

Claimants name ABHILASH SREEKUMAR

Employee number
Contact number +447752145553 821246
(must be legible)

Amount claimed
£112.61
(GBP only)

Original cost and

currency (including Original cost (original receipt showing value and currency to be attached) = £112.61
exchange rate
used) Exchange rate used (evidence of date and exchange rate must be attached too) =1

Although booking travel through the University system automatically gets me insured
on the University insurance schedule, this was set to expire by 1st August of this year. I
however needed to be insured for the entire duration of my stay in France i.e., April
15th 2019- October 15th 2019.

While I was convinced that the University would renew/extend the duration of the
coverage once we went past August 1st 2019, we were not so sure that the French
consulate granting my Visa would be convinced.

For avoiding any unnecessary delays on this end, my supervisor/project in-charge Dr.
Reason for claim Dimitrios Chronopoulos suggested I get a second private insurance coverage for this
period.

This, coupled with the uncertainty concerning Brexit further prompted us to get myself
doubly insured by an insurance firm based in Europe as well.

Regarding liability insurance:

For me to move into my accommodation in France for my six month secondment, the
landlord/organization handling the accommodation requires that I get a liability
insurance on the accommodation.

Receipts attached
X If no receipts are attached please enter reason why in the above box
(tick if applicable)

*Declaration by claimant

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 Travel and Expenses Services

Non Standard Expense Payment to Employee – Ad Hoc

By signing this claim form, I certify that the expenses have been wholly, exclusively and necessarily
incurred in the performance of my duties at The University of Nottingham. Any attempt to submit a
false claim will be treated as a serious disciplinary offence.

I confirm that I have been made aware of the purchasing and expenses policies and of the correct
route to purchase goods/services in the future. I acknowledge that the University may refuse to
reimburse expenses if these policies and procedures are not followed.

Expense policy: http://workspace.nottingham.ac.uk/display/TravelandExpenses/Expenses

Purchasing policy: https://workspace.nottingham.ac.uk/display/Procmt/Purchasing+Policy

*Signature (NOT
Date 30.05.2019
ELECTRONIC OR COPIES)

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 Travel and Expenses Services

Non Standard Expense Payment to Employee – Ad Hoc

Part 2a – Approval – budget holder**

Is this item taxable? It is the Approver’s responsibility (or their nominated person) to contact Tax
Services (Tax@nottingham.ac.uk) prior to approving this claim and also it is the approver’s
responsibility for this data being correct. Do not use this form for Visa’s.

(Please circle YES or NO as advised by tax services) YES* NO*

*You must attach the printed confirmation you have received from Tax Services along with
the receipts.

If you have circled YES, please complete one of the below options:

Option 1: Do you want the claimant to pay Tax & NI?

Please ensure that the claimant is notified

Option 2: Are you charging Tax & NI to the project code & not the claimant?
(Please attach email from payroll as proof of new figure)

If you have chosen Option 2 then please state revised amount given by Payroll Services

It’s the Approver’s responsibility to contact Payroll (PayrollSharedServices@nottingham.ac.uk) to

confirm the figure prior to completing this form. You will need to quote the employee number and
advise that the school are paying the tax and NI. The tax and NI must be on the recipient not the
person they purchased for if different.

Date when this figure was agreed with Payroll Services:

Authorised by
Contact number
(please print name)

Signature (NOT
Date
ELECTRONIC OR COPIES)

Job title

Project code
(must be quoted)

**Declaration by budget holder approver

I certify that the expenses have been properly incurred on University business and confirm that the
project code stated above can be charged for these costs. Any attempt to submit a false claim will
be treated as a serious disciplinary offence.

ONCE APPROVED PLEASE PASS TO YOUR LOCAL FINANCIAL MANAGEMENT OFFICE

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 Travel and Expenses Services

Non Standard Expense Payment to Employee – Ad Hoc

Part 2b – Approval – Financial Management***

Authorised by
Contact number
(please print name)

Signature (NOT
Date
ELECTRONIC OR COPIES)

Job title

If the value of this claim exceeds £1,000 approval for 2b must be countersigned by the Relevant Head
of Finance below:

Authorised by
Contact number
(please print name)

Signature (NOT
Date
ELECTRONIC OR COPIES)

Job title

***Declaration by Financial Management approver

I am satisfied that the criteria for this non-standard expenses claim have been met and have checked the
receipts/tax/payroll data for accuracy.  I confirm that the budget holder above is authorised to approve expenditure
on this project code.

How the payment is made

Payment will be made via Payroll Services with the claimant’s salary. If this claim is received and
approved by Travel and Expenses Services before the 14th of the month, the claimant will be paid that
month. If received and approved after the 14th of the month, payment will be made in the following
months’ salary.

Please send completed form to: Travel and Expenses Services, Room B50, King’s Meadow
Campus, NG7 2NR.

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Travel and Expenses Services

Non Standard Expense Payment to Employee – Ad Hoc

FOR TRAVEL & EXPENSES USE ONLY

Payment Code

Rejected
(Reason form
rejected)

Date returned to
Approver (FM)

Claim Input by Date

Other information

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