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

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.

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

Contact Information

Address

Surrey Coalition of Disabled People
Astolat, Coniers Way
Burpham, GU4 7HL