Host Family Claim Form – Crown Guardians

Host Family Details

Full Name

Email

Telephone

Payment Per Night

Address

City

Postcode

Student 1 Details

Full Name

School

Date from (dd/mm/yy)

Date to (dd/mm/yy)

Number of Nights stay

Travelling Expenses

(miles to and from school / trips)

Travelling from

Date of travel

Travelling to

Miles

Travelling Expenses 2

Travelling from

Date of travel

Travelling to

Miles

Additional Expenses

(eg. telephone, entertainment, pocket money, etc)

Additional Expenses 1

Details of expenses

Date

Total cost

Additional Expenses 2

Details of expenses

Date

Total cost

Student 2 Details

Full Name

School

Date from (dd/mm/yy)

Date to (dd/mm/yy)

Number of Nights stay

Travelling Expenses

(miles to and from school / trips)

Travelling from

Date of travel

Travelling to

Miles

Travelling Expenses 2

Travelling from

Date of travel

Travelling to

Miles

Additional Expenses

(eg. telephone, entertainment, pocket money, etc)

Additional Expenses 1

Details of expenses

Date

Total cost

Additional Expenses 2

Details of expenses

Date

Total cost

Student 3 Details

Full Name

School

Date from (dd/mm/yy)

Date to (dd/mm/yy)

Number of Nights stay

Travelling Expenses

(miles to and from school / trips)

Travelling from

Date of travel

Travelling to

Miles

Travelling Expenses 2

Travelling from

Date of travel

Travelling to

Miles

Additional Expenses

(eg. telephone, entertainment, pocket money, etc)

Additional Expenses 1

Details of expenses

Date

Total cost

Additional Expenses 2

Details of expenses

Date

Total cost

Summary of Totals Payable

Homestay

Total No. of Nights: 0

Total Amount £ 0

Travel

(£0.50 per mile)

Total Miles: 0

Total Amount £ 0

Additional Expenses

Total Additional Expenses Amount £ 0

Grand Total Payable (£'s): £0

Bank Payment Details

Details required only for first time payments or if your account details are different to those we already hold.

BACS Details

Bank Name

Account Name

Sort Code

Account Number

Cheque Details

If payment by cheque is prefered

Name on Cheque

Please note: BACS payment is preferred as payments are transferred directly into your bank account and waiting time for postage, paying in the bank and waiting time to be cashed is avoided. We aim to complete payments within 24 - 48 hours after receipt of the completed claim form.