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1. Expense Claim Form(Not Applicable)

Expense Claim Form

* indicates a required field.

This 'Expense Claim Form' needs to be completed and submitted by the 5th of the month.

You can progressively complete this form throughout the month however, please ensure you 'Save' each time you update the form.

Claimant details (Not Applicable)

Name

First name

Last name

Position *

Response required.

Chief Executive Officer

Employee

Clear

Declaration (Not Applicable)

I declare that all expenses incurred:

are related to Community Trust South business,
have not been claimed previously, and
comply with Community Trust South policy.

I have read and understood this declaration. *

Response required.

Yes

Clear

Date of claim *

Must be a date.

Expense period (Not Applicable)

From *

Must be a date.

To *

Must be a date.

Mileage (Not Applicable)

The vehicle reimbursement rate is 1.04 cents per kilometre for petrol, diesel, petrol hybrid, or electric vehicles. This rate is based on the Inland Revenue Commissioner’s vehicle expenses rates published 1 June 2024, and is for persons whose business travel is 5,000 kms or less in an income year.

Date of travel	Purpose	From	To	Kms
Must be a date.				Must be a number.

Must be at least 5 rows

Total kilometres

This number/amount is calculated.

General expenses (Not Applicable)

Receipts/invoices are required for all expenses claimed and these can be uploaded below. Please retain original receipts as these may be required for audit purposes.

Date	Description	Amount
Must be a date.		Must be a dollar amount.

Must be at least 5 rows

Total general expenses

This number/amount is calculated.

Wellbeing subsidy information (Not Applicable)

In line with the Trust's aspiration to provide a workplace that values and enhances the health and wellbeing of all employees and recognising the productivity benefits of a focus on wellbeing, the Trust provides employees with two types of subsidies to support the five ways to wellbeing and physical health.

This subsidy can be used for either;

a) Reimbursement of wellbeing activity; or

b) Equivalent value of time off work to participate in wellbeing activities such as volunteering.

Wellbeing expenses - Keep learning, Be active, Take notice (Not Applicable)

Date	Description	Amount
Must be a date.		Must be a dollar amount.

Must be at least 1 rows

Total wellbeing expenses claimed

This number/amount is calculated.

Receipts/Invoices for General and Wellbeing expenses

Attach a file: Upload new file

Please upload receipts/invoices

b) Participation/volunteer time - Give; or to Connect (Not Applicable)

Date	Description	Hours
Must be a date.		Must be a number.

Must be at least 1 rows

Total wellbeing hours claimed

This number/amount is calculated.

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Expense Claim Form

Claimant details (Not Applicable)

Declaration (Not Applicable)

Expense period (Not Applicable)

Mileage (Not Applicable)

General expenses (Not Applicable)

Wellbeing subsidy information (Not Applicable)

Wellbeing expenses - Keep learning, Be active, Take notice (Not Applicable)

b) Participation/volunteer time - Give; or to Connect (Not Applicable)

Total expenses claimed (Mileage, General + Wellbeing) (Not Applicable)

Grants Information:

Technical Assistance: