Claim for Motor Travel & Subsistence Expenses
Company Name:
Vehicle Registration:
Name:
Opening Kilometres: km
Period: –
Closing Kilometres: km
Date of Journey Base from which Travel is Measured Places Visited Purpose of Journey / Business Transacted Subsistence
(day / overnight)		 Receipt / Attachment
(required per journey)
TOTAL
Each row = one journey · attach a receipt to every row you complete

I declare that:

  1. the claim to motor travel allowances is in respect of expenses necessarily incurred in the performance of the duties of the office or employment;
  2. private mileage or journeys between home and place of employment are not included in the claim;
  3. the details furnished are in all respects true and correct.
Draw your signature above
Date:

The business travel in the above claim is correct. The reimbursement rate is in accordance with the rates and rules agreed with Revenue.

Certifying Officer:
Position:
Date:
📎 Important — Supporting Documents Required
  1. Attach a receipt or supporting document to every journey row you complete — the form will not submit without it.
  2. Accepted files: photos (JPG/PNG) or PDF. You can attach more than one file per journey.
  3. When you click Submit Claim, your claim and all attachments are sent straight to the accounts team.
✅

Claim Submitted!

Your travel & subsistence claim and all attachments have been sent to the accounts team. You'll be contacted if anything further is needed.