UMBRELLA EXPENSES CLAIM FORM Fax 0207 183 5561

FULL NAME Pedro de Sousa Marques DATE 30/08/2016 AGENCY Maple

Business Mileage
Date Travelled from Post Code Travelled to Postcode Return Journey Yes or No Total Mileage
22/08/2016 PO20 8NX GU28 9DA yes 50 Mileage rates are 45p per mile for a car with Vat fuel
23/08/2016 PO20 8NX GU28 9DA yes 50 receipt for the first 10,000 miles per tax year or 43p unrecipted.
24/08/2016 PO20 8NX GU28 9DA yes 50 Rates then drop to 25p and 23p per mile repesctivley once total
26/08/2016 PO20 8NX GU28 9DA yes 50 mileage exceeds 10,000
Motorbikes 24p per mile, Bicycles 20p per mile

Mileage claimed this week 90

Mileage claimed this year 1203,84
Total 1593,84

Total Mileage Claimed 200

Rate Claimed 0,45
Total Amount

TOTAL CLAIM FOR THIS FORM 90

I declare that the above expenses were wholly, exclusively and necessarily incurred in the course of the Umbrella Company's business and that I am personally liable for any additional income tax
resulting from any claim which is subsequently found to have been claimed in error. You are advised by HMRC to retain substantiate your expenses claim for a period of 7 years or alternatively supply them to us for safe keeping.

EMPLOYEES SIGNATURE Date 30/08/2016