Mileage Claim Form Template UK

The Mileage Claim Form Template UK is offered in multiple formats, including PDF, Word, and Google Docs, featuring editable and printable options for your convenience.

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Sample

Mileage Claim Form Template UK

Editable – Printable

PDF – 1 PDF – 2

Mileage Claim Form Template UK

1. Claimant Information



2. Employer Information


3. Trip Details


4. Mileage Information


5. Purpose of Trip

6. Additional Costs (if applicable)

7. Claim Amount Calculation

8. Declaration

9. Signature and Date



PDF

WORD

Examples

Mileage Claim Form Template UK (1)
Claimant Information:
[Name of the Employee]
[Employee ID]
[Department]
[Company Name]
[Claimant’s Phone]
[Claimant’s Email]
Travel Date:
[Date of Travel]
Purpose of Travel:
[Brief description of the purpose, e.g., client meeting, training, etc.]
Starting Location:
[Starting Address]
Destination:
[Destination Address]
Total Mileage Claimed:
[Total Miles Driven]
Mileage Rate:
[Rate per Mile, e.g., £0.45 per mile]
Total Claim Amount:
[Calculated Amount, e.g., Total Mileage Claimed x Mileage Rate]
Additional Expenses:
[List any additional expenses, e.g., parking fees, tolls, etc.]
Supporting Documents:
[List any attached documents, such as fuel receipts or toll tickets]
Declaration:
I hereby declare that the information provided is true and accurate to the best of my knowledge and that these expenses were incurred as part of my duties.
Signed: ______________________
Date: [Date of Submission]
Mileage Claim Form Template UK (2)
Claimant Information:
[Name of the Employee]
[Employee ID]
[Department]
[Company Name]
[Claimant’s Phone]
[Claimant’s Email]
Travel Period:
[Start Date] to [End Date]
Reason for Travel:
[Detailed description of the reason for travel]
Starting Location:
[Starting Address]
Destination:
[Destination Address]
Mileage Breakdown:
[Detail each leg of the journey with mileage, e.g., Start Point to Meeting Location and back].
Total Mileage Claimed:
[Sum of all miles driven]
Reimbursement Rate:
[Specify reimbursement rate set by the company]
Total Reimbursement Requested:
[Total Mileage Claimed x Reimbursement Rate]
Other Incurred Costs:
[List any incurred costs, such as accommodation if applicable]
Attached Evidence:
[Include any receipts or documents supporting the claim]
Claimant’s Certification:
I certify that the above information is accurate and reflects expenses incurred in line with my work responsibilities.
Signed: ______________________
Date: [Date of Submission]

Printable

PDF – 1 PDF – 2

Mileage Claim Form Template UK