Parliamentarians Travel Declaration
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1
2Form 4
Aug 2016
Page 1 of 2
PARLIAMENTARIAN’S TRAVEL DECLARATION
Options for returning your completed form
Scan and Email to:
MPSservicecentre@finance.gov.au
• Use this form to claim travelling allowance
• Please ensure all relevant fields are completed
Ministerial and Parliamentary Services
or Post to:
• This form must be lodged within 60 days of travel
• Privacy statement – see over
Department of Finance
One Canberra Avenue
FORREST ACT 2603
Last name
Enquiries:
Entitlements Management Branch
Home base / principal place of residence
Email:
emb@finance.gov.au
First name
Phone:
(02) 6215 3542
TRAVEL DETAILS
TRAVELLING ALLOWANCE
• Clearly identify each ‘leg’ of travel including those where TA is not being claimed
ACCOMMODATION TYPES:
DOCUMENTARY EVIDENCE
OF COMMERCIAL STAY
C
COMMERCIAL
• Non-consecutive nights must be identified by a separate line for each night/group of
Either:
NON-COMMERCIAL
NC
nights
ATTACHED
ATT
NOT REQUIRED (CANBERRA) NR
AVAILABLE ON
REQUEST
AOR
NOT REQUIRED (CANBERRA)
NR
NO. OF
T.A.
TYPE
TRAVELLING
TRAVEL
TRAVEL
SPECIFIC LOCATION STAYED
CONSE-
CLAUSE
ACCOM.
TRAVEL DATE
OF
ALLOWANCE
NAME OF MEETING/COMMITTEE AND/OR REASON FOR CLAIM
FROM
TO
I.E SUBURB/TOWN
CUTIVE
(SEE
RECEIPT
ACCOM.
STARTING DATE
NIGHTS
OVER)
• I declare that this travel was undertaken in my capacity as an elected representative and I acknowledge that a financial
loading will be applied if subsequent adjustment to this travel claim is required.
Signature
• I declare that the information I have given is true and accurate. I certify that I have fulfilled all the requirements of the
Date
Please print and sign this form
particular Remuneration Tribunal Determination clauses I have identified on this form.
/
/
• I understand that knowingly giving false or misleading information is a serious offence under the Criminal Code Act 1995.
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