Personal Expense Claim

Title:

Surname:

First name (s):

Email:

Phone:

Name of Partnership:

Period Covered (year ending...):

INCOME (Received direct – not via Practice bank account)

Private medical fees:

Locum fees:

Lecture fees:

Police Surgeon income:

Publishing / survey fees:

Clinical assistant salary:

Course fees reimbursed:

Other untaxed income:

Details: Details: Details:

GP Solo income (Gross):

GP Solo income (Superannuation):

GP Solo income (Additional Contributions):

Expenditure

Subscriptions (Not Medical Journals)

MDU / MPS:

GMC:

BMA:

RCGP:

Others:

Details: Details: Details:

Motor Expenses

Where possible please allocate costs to individual cars. If this is not possible enter what would be a fair allocation of such costs between the cars.

Reg:

Make:

Petrol / diesel:

Repairs / servicing / MOT:

Insurance:

Road Fund Licence (car tax):

AA/RAC subscription:

Cleaning (no estimates):

TOTAL:

Total Hire Purchase or loan repayments for year:

Loan interest per statements / certificate:

Mileage details: (from your log record) Mileage / Percent %

Practice:

Domestic:

Total:

Motor Vehicles (This section is only relevant if you have changed either car during the year)

Car Disposal

Car registration:

Car Sale / Part Exchange proceeds:

Date of sale:

Car Purchase

Car registration:

Car make / model:

Cost of car:

Date of purchase:

Sum borrowed (i.e. Loan / Hire Purchase):

Other Expenditure (not included in Practice accounts)

Home telephone (total cost):

Domestic use percentage

Mobile phone (total cost):

Domestic use percentage

Purchase of home burglar alarm:

Domestic use percentage

Maintenance of home burglar alarm:

Domestic use percentage

Stationery and postage:

Medical books and journals:

Postgraduate Trust subscriptions:

Course expenses:

Cleaning and laundry of work clothes:

Locum cover insurance premiums:

Locum fees:

Deputising fees:

Out of hours co-operative fees:

Drugs and medical supplies:

Repairs and replacement of medical instruments:

Details:

New equipment purchased:

Details:

Computer equipment purchased:

Domestic use percentage

Details:

Other computer expenses:

Details:

Other expenses:

Details:

Accessibility links

Personal Expense Claim

INCOME (Received direct – not via Practice bank account)

Expenditure

Subscriptions (Not Medical Journals)

Motor Expenses

Mileage details: (from your log record) Mileage / Percent %

Motor Vehicles (This section is only relevant if you have changed either car during the year)

Car Disposal

Car Purchase

Other Expenditure (not included in Practice accounts)

Are you a Dentist?

Are you a Hospital Doctor?

Are you a GP or Locum?