Expenses declaration form

If you are looking to claim reimbursed expenses, please complete the Reimbursed Expenses Declaration form below. If you have any questions, please contact the Churchill Knight Umbrella team on 01707 669026 or umbrella@churchill-knight.co.uk.

Please be aware that you are completing the form for one working week (Monday - Sunday). If you started work later in the week that went beyond Sunday (e.g. Thursday - Wednesday), you will need to complete the form twice (Thursday - Sunday and Monday - Wednesday).

You cannot claim expenses for future periods.
Your Details
First Name*
Last Name*
End-Client*
Recruitment Agency*
Email Address*
Today's date
Your Expenses Claim Period
Please select the Week Commencing Date to unlock the rest of this form.
The End of Week Date will be automatically calculated based on the commencing date and cannot be altered.
Week Commencing Date*
DD slash MM slash YYYY
End of Week Date
Please confirm how many days you worked during period*
Are you claiming mileage expenses?*
If you are claiming mileage expenses, please click yes. You will then be required to provide us with information about your claim and your vehicle. Don't forget to attach the relevant receipts. If you are not claiming mileage expenses, please click no and move onto the next section.

Are you claiming additional expenses (non-mileage)?*
If you are claiming expenses that are not mileage, please click yes and you will be required to provide us with information for each claim. Don't forget to attach the relevant receipts. If you are not additional (non-mileage) expenses, please click no and move on to the next section.

Your Address
House Number/House Name*
Street Address*
Town/City*
County*
Postcode*
Declaration
I confirm that my expenses are wholly, exclusively and necessarily incurred in the course of performing employment duties.*
I confirm that where I am claiming expenses related to travel that I am working on a temporary assignment and I do not expect continuous work at the same location for 24 months.*
I confirm that I have already, or expect to undertake more than one assignment for Churchill Knight Umbrella and that I do not expect my current assignment with Churchill Knight Umbrella to be my last.*
I confirm that if I am found to be falsifying expense claims I will face disciplinary action.*
Phone
This field is for validation purposes and should be left unchanged.

Date of the Expense	End-Client	Travel To (Postcode)	Travel From (Postcode)	Amount you are claiming (£)	Distance Travelled (Miles)	Reason For Journey	Was this a return journey?	Did you make the same journey on other days in the week? If so, please select every date.
*		*	*	*	*	*			Click to add extra mileage expense

Date of the Expense	What was the Expense?	Value of the Expense (£)	Reason for the Expense	If this expense claim involves an overnight stay, please enter the postcode below. If not, leave blank.
*	*	*	*		Click to add extra expense

Your Details