TABLE OF CONTENTS

Submitting Expense Claims

Example 1

1.    I certify that this is a true record of the journeys and official duties completed whilst in the service of the Trust. 

2.    The expenses claimed have actually and necessarily been paid by me and any claims for subsistence are claimed as I necessarily spent more than I would normally have done, had I been present at my permanent base. 

3.    I further certify that the motor vehicle, if not a Lease Car, is insured for at least third party insurance cover for business use. 


4.    I further certify that the car has a current MOT certificate (if required) and has been maintained in accordance with the manufacturer's guides.


I declare that the information I have given on this form is correct and complete and that I have not claimed elsewhere for the expenses/mileage detailed on this claim. I understand that if I knowingly authorise false information this may result in disciplinary action and I may be liable for prosecution and civil recovery proceedings. I consent to the disclosure of information from this form to be used by the Trust for the purpose of verification of this claim and the investigation, prevention, detection and prosecution of fraud. 


Example 2

I declare that the information I have given on this claim is correct and complete and that it is in accordance with the Travel and Expenses Policy. I understand that it will be subject to verification checks, audit review and will also be provided to the Local Counter Fraud Specialist as required.


I also certify that I meet the criteria for the user status claimed.


I certify that my motor vehicle (registration number overleaf) is currently maintained in a roadworthy condition and that the insurance policy provides cover whilst the vehicle is used on official business for third party insurance including cover against risk of injury to or death of passengers and damage to property, and that the policy is now in force and covers the journeys claimed.  


I further certify that I hold a valid driving licence for the category of vehicle and that the licence remains valid and covers the journeys claimed. I confirm that I have incurred additional expense over and above that which I would normally have incurred at base for any and all subsistence claims made. 


Example 3

I DECLARE that the travelling and other expenses have been claimed in accordance with NHS Regulations  and  were actually and necessarily incurred whilst engaged on business activities to enable performance of my duties required by my employment within the CCG.   


I FURTHER declare that official travel rate is only claimed for journeys where public transport is not available or considered not practical for that journey. 


I CERTIFY that a current Insurance Policy is in force for the motor vehicle used and provides cover for the claimed journeys.  Also when used on CCG business or activities full third party cover extends to injury or death of passengers and damage to property. 


I FURTHER CERTIFY that my claims for "Other Expenses" were actually and necessarily incurred in the performance of CCG business activities.  Furthermore, any claim for meals was an essential additional cost.  


I UNDERSTAND that if I provide false information I may be liable for disciplinary, prosecution and civil recovery proceedings. I consent to the information provided being used for the purposes of the prevention, detection and investigation of fraud. 


Example 4

I certify that the information in this claim is correct, complete and reimbursement is claimed in accordance with Trust policies.  I understand that it will be subject to verification checks, audit review and will also be provided to the Trust Local Counter Fraud Specialist as required.            


For all subsistence allowances claimed, I confirm that I was working away from my normal base, over the required time period, and that I incurred actual additional expense for the meal allowance claimed. 


I certify that my vehicle is maintained in a roadworthy condition, it was covered for business use by an insurance policy providing full third-party insurance cover against risk of injury to or death of passengers and damage to property and I hold a valid driving licence for the category of vehicle which covers the journeys claimed. 


Colleagues should be aware that Trust has a zero tolerance to fraud and that any claims found to be false may result in disciplinary, criminal or civil sanctions, or a combination of these as appropriate.


Example 5

1. I hereby confirm that I have read and understood the organisation's policies and procedures on claiming expenses.  To the best of my knowledge and belief the expenses claimed are in accord with those policies and procedures, and have been actually and necessarily incurred by me whilst on official business and in the most economical manner. I have not made and will not make any other claim for the expenses itemised on this form. 


2.    The driver is required to complete the 'Driving for Work' LMS module if they commute between offices or perform business activities on behalf of the NHSBSA and has the necessary insurance and paperwork to carry out this activity. The driver is required to notify the Corporate Services Business Manager that they hold a valid full drivers licence and disclose any notifiable medical condition or disability, disqualification and/or suspension or special terms imposed by the DVLA and any driver under 25 years of age.  I understand that I will not be entitled to drive the vehicle unless I am subsequently authorised and approved by the NHSBSA to do so. 


3.    I understand that if I knowingly provide false information this may result in disciplinary action and I may be liable for prosecution and civil recovery proceedings. 


4.    I consent to the disclosure of information from this form to and by the NHSBSA for the purpose of verification of this claim and the investigation, prevention, detection and prosecution of fraud. 


5.    Please tick to accept the above conditions. 


Approving Expense Claims

Example 1

I am an authorised signatory, with appropriate budgetary authority and confirm that the expense claims I am authorising are, to the best of my knowledge, accurate and I approve payment.  I understand that if I knowingly authorise false information this may result in disciplinary action and I may be liable for prosecution and civil recovery proceedings.  I consent to the disclosure of information from this form, to and by the Trust and NHS Protect for the purpose of verification of this claim and the investigation, prevention, detection and prosecution of fraud.  


I will ensure that I bring to the attention of the appropriate individuals in line with our Anti-Fraud Bribery and Corruption Policy and Response Plan, any questionable claims which may constitute fraud.


Example 2

I certify that the claimant was engaged on the duty stated on the dates shown and that the claim made for mileage, expenses and subsistence is in accordance with the regulations and policy. 

I certify, that I have checked the receipts for any expense reimbursement claimed on this claim.  


Example 3

I CERTIFY to the best of my knowledge and belief that the claimant was engaged on journeys stated on the dates shown.  I am an authorised signatory for my department and I APPROVE payment of the claim, including the payment of mileage rates in excess of public transport rate and other expenses claimed above. 


I am approving the claim to declare that the information that I have authorised is accurate. I understand that if I authorise false information actions may be taken against me. 


Example 4

I certify that the claimant was engaged on the duty stated on the dates shown and that the claim made for mileage, expenses and subsistence is in accordance with the regulations and Trust policies, and I approve payment. 


Approvers should be aware that Trust has a zero tolerance to fraud and that any claims found to be false may result in disciplinary, criminal or civil sanctions, or a combination of these as appropriate.


Example 5

1.    I understand my duty as approving officer and certify that, to the best of my knowledge and belief, the facts given in this claim are correct, that the expenses were actually and necessarily incurred on official business in the most economical manner and that the expenses claimed comply with the rules of this organisation. 


2.    I attach a note justifying why I have approved expenses above the normal limits. 


3.    The expenses incurred were disbursed solely in relation to the public service. 


4.    Please tick to accept the above conditions. 


Submitting Vehicle Details

Example 1

I certify that my vehicle has a valid MOT certificate (if required), it is covered for business use by an insurance policy providing full third-party insurance cover against risk of injury to or death of passengers and damage to property and I hold a valid driving licence (at current address) for the category of vehicle which covers the journeys claimed.  


Approving Vehicle Details

Example 1

I certify that I have fully checked all Duty of Care documents prior to approving them on the system. 


Approvers should be aware that the Trust has a zero tolerance to fraud and that any claims found to be false may result in disciplinary, criminal or civil sanctions, or a combination of these as appropriate.