UCD Registry
Assessment
Clárlann UCD
Measúnú
INVIGILATION CLAIM FORM
Surname:
Telephone:
First Name:
Email:
Exam Centre/Hospital:
P
Personnel Number:
Role:
1. Standard
Invigilator
2. Assistant to Team
Leader
3. Team Leader
4. Hospital
5. Amanuensis
6. Deputy IIC
7. IIC
Day
Date
Time worked
from
Time worked
until
Total No. of
Hours
Initial of
Invigilator in
Charge /
Head of School/
Hospital
Administrator
PAYMENT RATES
Have you invigilated in the Irish Public Sector prior to September 2012?
Please tick as appropriate:
Yes
No
A New Entrant rate will be paid to any invigilator who has not invigilated in the Irish Public Sector prior to September 2012.
PENSION INFORMATION
Are you a member of a public service pension scheme, entitled to a benefit under a public service pension scheme or receive a
payment or allowance in lieu of membership of a public service pension scheme (other than a UCD Pension Scheme)?
Please tick as appropriate:
Yes
No
If yes, please complete the Pension Related Deduction Form, available at HR Forms and forward it to the Compensation and
Benefits Unit, UCD HR.
If you have already submitted a declaration form, please sign the claim form and return it for payment.
I certify that the details claimed above are correct
Signed: Invigilator
Date:
AUTHORISATION
By Invigilator in Charge/Head Of School/Hospital Administrator
Print Name - BLOCK
Signature:
Name of School:
Date:
Please note:
 It is the invigilator’s responsibility to complete this form accurately. Incomplete forms will not be processed.
 To receive payment you must ensure that you have filled in the correct Personnel Number on this claim form. Any
queries please email: invigilation@ucd.ie
For Assessment Use Only:
Approved:
Date:
Please return completed forms to:
Invigilation, Assessment, UCD Registry, Tierney Building, Belfield, Dublin 4
Phone: +353 1 716 1689/1389/1769
Fax: +353 1 716 1198
Email: invigilation@ucd.ie
Web: www.ucd.ie/registry/assessment