Payroll use only

Claim for Work and Related Expenses for Casual Workers

PAY01aDate Received

This form must be filled in electronically and printed before signing Please keep a copy for your records.

Section 1 Mandatory InformationIf the following information is incomplete, this form will be returned unpaid. (Reference information can be found on your letter of assignment)

PAYROLL NUMBER Assignment Number

Name Faculty / Department

Hourly Rate P/Hour or Daily Rate P/DAYSection 2 Time Sheet SummaryThe following information will populate automatically on completion of the detail information in section 3

Total Decimal Hours Claimed Total Amount DueOr

Total Days Claimed Total Amount DueSection 3

Complete when paid P/Hour Complete when paid P/Day Complete for all claimsDATE Start time End time or Amount £ Description of work Performed

0:00 0 £0.00 £0.00

0:00 0 £0.00 £0.00

0:00 0 £0.00 £0.00

0:00 0 £0.00 £0.00

0:00 0 £0.00 £0.00

0:00 0 £0.00 £0.00

0:00 0 £0.00 £0.00

0:00 0 £0.00 £0.00

0:00 0 £0.00 £0.00

0:00 0 £0.00 £0.00

0:00 0 £0.00 £0.00

NO TIME SHEET WILL BE PROCESSED UNLESS THERE IS A LIVE ASSIGNMENT RECORDED WITHIN THE HR SYSTEM, ANY TIME SHEET RECEIVED WHERE NO RECORD IS PRESENT WILL BE RETURNED AND IT WILL BE REQUESTED THAT THE MANAGER CONTACT HR TO ENABLE A POSITION AND ASSIGNMENT TO BE SET UP.

Total Leave Accrued (Decimal hours and paid)

Total Leave Accrued (Decimal hours and paid)

Length of Break (in mins)

Hours Worked (Excluding Breaks)

Days claimed

Proportion of day worked (e.g. 1.0 for whole day , 0.5 for half day etc.)

Holiday pay paid for accrued leave

Project Code (Mandatory). THIS MUST BE THE PROJECT CODE PROVIDED ON THE MANAGER REQUEST FORM FOR THE ASSIGNMENT IN ORDER FOR PAYMENT TO BE MADE

DATE Start time End time or Amount £ Description of work PerformedLength of Break (in mins)

Hours Worked (Excluding Breaks)

Days claimed

Proportion of day worked (e.g. 1.0 for whole day , 0.5 for half day etc.)

Holiday pay paid for accrued leave

Project Code (Mandatory). THIS MUST BE THE PROJECT CODE PROVIDED ON THE MANAGER REQUEST FORM FOR THE ASSIGNMENT IN ORDER FOR PAYMENT TO BE MADE

0:00 0 £0.00 £0.00

0:00 0 £0.00 £0.00

0:00 0 £0.00 £0.00

0:00 0 £0.00 £0.00

0:00 0 £0.00 £0.00

0:00 0 £0.00 £0.00

0:00 0 £0.00 £0.00

0:00 0 £0.00 £0.00

0:00 0 £0.00 £0.00

0:00 0 £0.00 £0.00

0:00 0 £0.00 £0.00DETAILS OF EXPENSES CLAIMED RELATING ONLY TO THE ABOVE WORK PERFORMED.Expense only claims should be made on form EXP1 (staff) or EX2 (non-staff)

Date Mileage Rate (£) Amount (£) Description Payroll Code Comments (if required)

Claimants Declaration-I certify that this claim is a true and accurate record of the work and expenses claimed in accordance with my agreement with the University

Signature Date

Authorisation(In absence of a claimant signature, I confirm that signed backing documentation is retained in the department for monies claimed)

Signature Print name Date Position

Project Code (Mandatory)

Extension No For Queries