Expenses : Umbrella Cymru

Name*
First Last
Email*
Date*
This is the date you incurred the expense, NOT the date you are submitting the claim.
DD dash MM dash YYYY
Description*
If this related to a case, please provide the case reference number here (e.g. UC-CR-1800????). If this relates to anything else, please describe the purpose of your travel, or expenses claim (for example, induction training).
Have you completed an Account Set-up form?*
If you have previously submitted a claim you will have completed this form. You might have also completed it separately. If you have, you may continue with your claim. If not, please call us before completing the following section.

Save and Continue Later

Claim
Line one*
Please select the type of expense you are claiming. You can add multiple claims in one form.
Miles*
Please enter the total number of miles travelled.
Amount Claimed
The amount below shows the value of mileage being claimed. If this is incorrect, please overwrite the value.
Description*
Amount*
Copy of receipt
Please upload a copy of your receipt or invoice. You can do this by scanning the document to your computer, or uploading a photo using a smartphone.
Max. file size: 512 MB.
Are you claiming for anything else for the date you entered above?*

Save and Continue Later

Line two*
Please select the type of expense you are claiming. You can add multiple claims in one form.
Miles*
Please enter the total number of miles travelled.
Amount Claimed
The amount below shows the value of mileage being claimed. If this is incorrect, please overwrite the value.
Description*
Amount*
Copy of receipt
Please upload a copy of your receipt or invoice. You can do this by scanning the document to your computer, or uploading a photo using a smartphone.
Max. file size: 512 MB.
Are you claiming for anything else for the date you entered above?*

Save and Continue Later

Line three*
Please select the type of expense you are claiming. You can add multiple claims in one form.
Miles*
Please enter the total number of miles travelled.
Amount Claimed
The amount below shows the value of mileage being claimed. If this is incorrect, please overwrite the value.
Description*
Amount*
Copy of receipt
Please upload a copy of your receipt or invoice. You can do this by scanning the document to your computer, or uploading a photo using a smartphone.
Max. file size: 512 MB.

Save and Continue Later

Confirm and Accept*
I confirm that the information provided in this form is accurate to the best of my knowledge, and I accept that mistakes made in the form could result in my claim being rejected.
- I accept / Confirm

Save and Continue Later

Expenses