Name of Employee		
		
Institution		
		
Category of Staff		
		
Date employment commenced		
		
Address for correspondence

(Include e-mail address & telephone number)		

Payroll Number:

Last four digits of Bank A/C

Description of Expense (Receipted invoices and documents should be attached)

	£ (Sterling)	
1.	Legal and other costs of sale and purchase of property		
Solicitors’ fees 		
Search, survey and property enquiry fees		
Mortgage arrangement/redemption fees		
Estate agents’ fees or advertising costs		
Valuation Fees		
Conveyancing 		
Stamp duty		
Land registry fees		
Registration fees		
2.	Removal and travel costs		
Removal costs		
Excess baggage allowance		
Travel costs		
Storage costs		
Total Claim (to maximum of £8,000)		

Employee’s Declaration
I confirm that I am seeking reimbursement for relocation because I am changing my main residence and not acquiring a second home.  
I agree that I will pay all or part of the amount reimbursed if I leave the University’s employment within three years, as specified in Repayment Conditions paragraph.

Signature		Date		

Claim approved by (Head of Institution/comparable authority)

Signature		Date		
Printed Name				

Note to approving body:
Send approved claims for centrally funded staff to Office Manager, Finance Division, Greenwich House, Madingley Road. Send approved claims for non-centrally funded staff to your School Finance Manager with your cost code inserted here: