Shared Lives

Invoice Mileage for Short break

Individual Details	Carer Details

Name:	Name:
Address:	Address:
Telephone No:	Telephone No:
Duration of Short Break:

Claim - 45 pence per mile when the journey is specifically for the individual in Short Break or Day Support.

This payment will need to be paid at the end of each Short Break directly to the Carer whom is supporting the individual.

Journey Details

Date	Journey	Return Y/N	Total Mileage	Cost

Total Cost: £

Signature:	Carer Signature:

Further comments and notes prior to Short Break commences i.e. arrangements agreed