Overtime (02/2013) (PAE)
Overtime Claim Form
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Forms must reach the Payroll Office, King’s Gate, no later than the 12 day of each month for Payment at the end of that month.
Academic/Service Unit: ………………………………….........……...........................
Month Ending: ……………………..
Description of work
Contracted Normal Working
Actual Times Total
Personnel performed and reason for Weekly
Days & Daily
Day
Date
Overtime
Overtime Wage
Full Name
Number
Overtime
Hours
Working Hours Worked Worked worked
Hours
Type
Cost Assignment
** If different to employees
Home cost centre
CLAIMANTS SIGNATURE
AUTHORISING SIGNATORY
VERIFYING SIGNATORY
FOR PAYROLL USE ONLY
I confirm that the payment now claimed is
for hours of work which have been
previously approved, have been worked
and are correctly recorded
I confirm that payment for hours of work
claimed has been approved in advance and
that the work is necessary for the benefit of the
University. In addition, that the work has been
carried out during the hours shown on the
claim form
I confirm the Authorising Signatory is
valid
Signed ……………………………………….
Signed …………………………………………
Signed ………………………………….
Input by …………… Date …….……..
Date …………………………………………
Name (Block letters) ………………………….
Name (Block letters) ………………….
Check by ……….… Date ……….…..
Date …………………………………………
Date ……………………………………