Demonstrating Fees Claim Form

Month: August
Year: 2017

Have you received a contract? Yes

Claimant

Important: A Postgraduate Student Title: Mr

Demonstrating Contract MUST be in place
before payment can be made. Contracts Surname: Vader
should be requested via the Temp Bank. Forenames: Darth
Date of Birth 4 May 2845

Payroll Information
National Insurance Number: D S 4 4 4 3 2 1D
Pay Reference Number: 1 2 1 2 1 2 1
Student Number: 1 2 3 4 4 3 2 1

Bank/Building Society Galaxy Bank

Branch Tatoine
Sort Code 4 3 2 4 2 2
Account Number 7 0 6 0 5 0 4 0
Building Society Ref:

If you have made a previous claim, and there are no changes to your
bank details, please leave the section blank.
Hours Claiming
Week Commencing Mon Tues Weds Thurs Fri Sat Sun Total
7/31/2017 0
8/7/2017 7 7 14
8/14/2017 7 1 7 15
8/21/2017 7 7
8/28/2017 7 7 14
9/4/2017 7 7 14
IMPORTANT: If you have a Tier 4 visa, or are completing supplementary Total 64
work on a Tier 2 or Tier 5 visa, you must complete the table below detailing
hours worked each week accurately and in line with your visa restrictions.
Do you have a Tier 2, a Tier 4 or a Tier 5 Visa? Yes

Authorisation
Faculty
Faculty Authorised Signature
Budget-holder's Signature
Date

Cost Centre £
555555555 600.00 I confirm that the hours
444444444 300.00 worked are accurate, correct
333333333 30.00 and comply with any visa
restrictions that may apply to
the worker.
Total £ 930.00
January 2016 Mr Yes 1
February 2017 Mrs No 2
March Ms 3
April Miss 4
May Prof 5
June Dr 6
July 7
August 8
September 9
October 10
November 11
December 12
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