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Co-production Payment Form
Co-production Payment Form
Your Contact Details
Name
(Required)
Date of birth
(Required)
Address
(Required)
Street Address
Town
County
Postcode
Email
(Required)
Phone
(Required)
How would you prefer us to contact you? (Email, phone or post)
Preferred time of day to be contacted by phone, if any:
Are you a Coalition Member
Yes
No
If no, would you like to be contacted about becoming a member?
Yes
No
Co-production Activity
Name of Activity
(Required)
Number of hours completed. Paid at £15 per hour
(Required)
Commissioner approval
(Required)
How would you like to receive the payment?
Vouchers – please specify which company you would like the vouchers for
Payment into bank account – please provide bank details
Travel Expenses (If applicable)
Please note, all travel expenses will be a paid into your bank account. If you haven’t already provided us with your bank details, please provide them below:
Account Name
Bank
Account Number
Bank Sort Code
Please select from the list below:
Mileage
Taxi
Bus
Car Parking
Rail
Details of journey - From
Details of journey - To
Amount
Mileage will be paid at 45p per mile as per the government guidelines.
Please submit your receipts for Taxi/Bus/Rail and car parking expenses.
Drop files here or
Select files
Max. file size: 40 MB.
Please note, we aim to get your payment to you within 2 weeks of the event. Payments are made on the second and last Friday/Saturday of the month.
Consent
I consent to Surrey Coalition of Disabled People storing and processing my personal information in order to manage and communicate with me regarding my application.
hCaptcha
(Required)
I've not been out for ages; it was really lovely to get out.
- Get More Active Get Together attendee
Simple acts of kindness that can transform somebody's day to day life
- Tech to Community Connect member
