This form is designed to record any benefits you have received from your
Company, and any expenses you have reclaimed from the Company.
When you submit this form a copy will be sent to the relevant office
chosen below and a copy will also be mailed to you as confirmation
that the information has been sent.
Details and totals of any other expenses reimbursed by the Company (detail
below)
By clicking submit I hereby formally claim relief on the expenses detailed in sections 4 to 8 above, under Section 198(1)
TA 1988 on the grounds that these were incurred wholly, exclusively and necessarily in the
performance of my duties as an employee of the above Company
