HEALTHCARE INFECTION SOCIETY EXPENSES CLAIM
Please complete and:
Post/email this form to:
Ruth Gonzalez De Bulnes at
162 Kings Cross Road
London WC1X 9DH
ruth@his.org.uk
Details of claimant:
Name
Address
Bank Account Details
Account Number:
Short Code:
TRAVEL EXPENSES
date
from
to
TOTAL
mileage/
fare (£)
purpose
(A)
OTHER EXPENSES
date
description
TOTAL
Grand total: (A) + (B)
Approved by………………………………..
Date…………………………………………
cost (£)
(B)
purpose