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TEMPLATE Reimbursement form

Assalamu alaykum!
Please fill in this form to be reimbursed for any travel expenses.
The costs that will be covered include:
Car -  £0.30 per mile.
Public transport - Public transport costs will be reimbursed. To ensure responsible use of charity funds, bookings made after the 9th of August will be reimbursed at 75% of the ticket cost.
You are eligible for reimbursement of the journey there and the journey back, please put the final total below, and indicate in the extra information box whether it is for both ways or one way.

Please enter your name

Please enter your email

Please select the description of the expense being claimed

Amount of reimbursement

Currency?

Please enter your bank details

Please enter your contact number

Any other information we should be aware of?