Surrey and Borders Partnership Co-production Easy Read Form

About You

Your name(Required)

Your email address(Required)

Phone Number(Required)

Co-production Activity

Name of Activity(Required)

How many hours did you complete?(Required)

How would you like to be paid?

How would you like to be paid?(Required)

Bank

Vouchers

If being paid into your bank, please provide your bank sort code and account number(Required)

If being paid by vouchers, where would you like your vouchers for?

Do you have any travel expenses?

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 on the previous section.

Please select from the list below:

Mileage

Taxi

Bus

Car Parking

Rail

Details of journey - From location

Details of journey - To location

Amount

Mileage will be paid at 45p per mile as per the government guidelines.

Please upload your receipts for Taxi/Bus/Rail and car parking expenses.

Drop files here or

Max. file size: 100 MB.

Agreement and signature

Data Protection(Required)

I understand that my information will be held in line with my rights under the General Data Protection Regulations (GDPR). 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. For more information, please review our Privacy policy https://surreycoalition.org.uk/privacy-policy/

Signature

Please type your name in this box

This form has been made with Photosymbols and Pixabay images

Now please click on the button to submit your form.

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