THE INSTITUTE OF PHYSICS – EXPENSES CLAIM FORM



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THE CARERS’ FUND

Application Form

The Institute has established The Carers’ Fund to provide members with a grant to contribute towards additional costs of paying for carers when attending physics-related events, meetings and conferences.

Applications may be submitted at any time prior to the event and confirmation of eligibility will normally be given within two weeks. Payment will be made on completion of a short form following attendance at the event. Retrospective awards will not normally be considered.

Please see attached notes for further details of the grant.

Please contact carersfund@ if you have any queries.

1. Personal details

|Name (including title) | |

|Address | |

| | |

|Postcode | |

|Email Address | |

|IOP Membership Number | |

2. Event Details

|Name of Event | |

|Date of Event | |

|Approx. Time of Event | |

|Place of Event | |

| | |

|Reason for attending | |

|URL for event if available | |

3. Who do you care for?

|Number of people/children that you normally care | |

|for and ages if they are under 16. | |

|Relationship to him/her/them | |

|Care arrangements normally used | |

|Reasons for additional care requested | |

4. Support requested

|Type of additional care requested | |

|Total amount of claim up to £250 | |

| | |

Please specify if you have requested or obtained support for these costs from any other source

|Source | |

|Amount | |

Have you applied for a grant from the Carers’ Fund before? Yes No

|If yes, please give amount, and date of award | |

5. Payment details

For all payments:

|Bank name: | |

|Account name: | |

|Bank address | |

For UK payments:

|Sort code: | |

|Account number: | |

For European payments:

|SWIFT/BIC code: | |

|IBAN number: | |

For US Banks:

|ABA or FEDWIRE number: | |

|Account number: | |

For payments to other countries:

|Bank ID (SWIFT/BIC code): | |

|Account number: | |

| |

If you prefer to be paid by cheque, please indicate here:

(Please note that cheque payments take longer and you may incur cheque negotiation charges)

The information you provide on this form will only be used to assess your application and, if successful, to make payment of the grant. Information which is necessary to make the payment will be shared with our subsidiary company, IOP Publishing Limited, who will process the payment on our behalf.

I understand that payment will be made once I have returned a short report following attendance at the event. I confirm that the above details are correct.

Signature Date

(Please type or scan name if returning this form electronically)

Please return this form to

Email: carersfund@

Post: The Carers’ Fund, Diversity Team, Institute of Physics, 37 Caledonian Road, London N1 9BU

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