Expenses

Your name*
Name of the worker*
Name of the package*
Expenses type:*
- Mileage
- Travel time
- Bonus
- Additional expenses
- Back dated missed pay
- Non-Chargeable Shadow Shifts
- Deduction
- Refer a friend
Please provide details for the deduction:
Please enter the monetary amount of mileage
Mileage rate is £0.45 per mile
Please enter the monetary amount of travel time
Travel time is paid at £11.00 per hour
Please enter the monetary amount of the bonus to be paid
Please enter the monetary amount of the shadow shifts to be paid
Please give the name of the colleague referred*
Have you had confirmation that they have successfully completed 200 hours?*
- Yes
- No
Please give a brief reason for the bonus payment*
Please enter the monetary amount of additional expenses
Please enter all the information requested relating to the missed pay*
Client, Shift date, shift start time, shift end time.
Please enter the number of hours to be back paid*
Please enter the monetary amount to be back paid*
Has a timesheet been created for the missing pay?*
- Yes
- No
Please give a reason why a timesheet has not been created for the backpay*
Please give a brief reason for the back-dated missing pay

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Libertatem
Head Office Libertatem Healthcare Group Trinity Court Molly Millars Lane, Wokingham RG41 2PY
01189 730006
info@libertatemhealthcare.co.uk

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