Mileage Expense Claim Form
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1
2Mileage Expense Claim Form
Date:
Engine Size
Name:
Vehicle Reg:
1400cc or less
Petrol
1401cc to 2000cc
Diesel
Over 2000cc
No. of
Tolls £
From / To
Purpose of Journey
Miles
Date
Passengers
Parking £
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Total Miles
Continue overleaf if necessary
Total Passenger Miles
< 10,000
> 10,000
Mileage this Year b/f
Miles
x
x
Mileage this Month
x
Passenger Rate
5p
Mileage Rate
Mileage this Year c/f
=
=
=
Amount Due
+
+
Signature:
=
Passengers
Tolls/Parking
Miles
I confirm the hours claimed are true and accurate
£
Amount Reimbursed
Please remember to attach your fuel / car park receipts
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Parent category: Business