<p> GP REGISTRAR</p><p>APPLICATION FOR ASSISTANCE WITH RELOCATION EXPENSES</p><p>APPLICANTS NAME DR ______DORSET FAMILY HEALTH SERVICES AGENCY</p><p>DECLARATIONS IN RESPECT OF RELOCATION EXPENSES</p><p> I hereby make application for assistance with relocation expenses actually and necessarily incurred by me in connection with my new appointment and I hereby declare that the information and costs incurred and included by me in this application are correct in all details.</p><p>Signed ______Date ______</p><p> I hereby undertake to repay a proportion of any relocation expenses received, if I leave my post within 6 months of the commencement of the contract period/ training programme. The proportion will be calculated by reference to that element of my contract of employment /training programme I have worked to the full length of my contract of employment/training programme.</p><p>Signed ______Date ______</p><p> I certify that all of the expenses in connection with this Application claim are not recoverable in full or in part from any other source, and that no other member of my family is eligible to claim relocation expenses in respect of this relocation. I also certify that I have not received a Miscellaneous Expenses Grant in the last two years. </p><p>Signed ______Date ______APPLICATION FOR ASSISTANCE WITH RELOCATION EXPENSES</p><p> NAME OF APPLICANT ______(BLOCK LETTERS)</p><p> NEW APPOINTMENT </p><p>Post ______</p><p>Grade & Salary ______</p><p>Wholetime/Part-time ______</p><p>Date of Commencement ______</p><p> PREVIOUS APPOINTMENT</p><p>Authority/Trust ______</p><p>Post ______</p><p>Grade & Salary ______</p><p>Wholetime/Part-time ______</p><p>Permanent/Locum* ______</p><p>Termination date ______</p><p>(* If locum appointment (s) please give details back to previous permanent post.)</p><p> PRESENT ADDRESS ______</p><p>______</p><p> PREVIOUS ADDRESS ______</p><p>______</p><p> DATE OF REMOVAL ______DETAILS OF ACTUAL EXPENSES INCURRED</p><p> Removal of Household furniture and effects (attach 3 tenders) </p><p>Lowest tender £______</p><p>Storage charge (if any) £______</p><p>Insurance: Extra cost of Insuring furniture in storage or transit. £______</p><p>TOTAL CLAIMED £______</p><p> Legal Expenses in connection with Purchase of Property *</p><p>Solicitors Fees £______</p><p>Stamp Duty £______</p><p>Land Registration fees £______</p><p>Survey fees £______</p><p>Drains Testing £______</p><p>Private Survey Fees £______</p><p>Incidental Legal Expenses £______</p><p>Other £______</p><p>TOTAL CLAIMED £______</p><p>PURCHASE PRICE OF PROPERTY £______</p><p> Legal Expenses in connection with Sale of Property *</p><p>Legal cost of sale ( including expenses in redemption of mortgage) £______</p><p>House Agents or Auctioneers fees £______</p><p>Advertising costs £______</p><p>Incidental Costs £______</p><p>TOTAL CLAIMED £______</p><p>SELLING PRICE OF PROPERTY £______DETAILS OF ACTUAL EXPENSES INCURRED</p><p> Cost of Tenancy Agreement – Rented accomodation *</p><p>Cost of Agreement (tenant’s share) £______</p><p>House Agents fees (tenant’s share) £______</p><p>Cost of Drains Testing £______</p><p>TOTAL CLAIMED £______</p><p> Travelling and Subsistance Expenses * </p><p>Preliminary Visit</p><p>Date ______</p><p>Subsistance Allowance £______</p><p>Mileage claimed ______</p><p>Journey from Old to New Home</p><p>Date ______</p><p>Subsistance Allowance £______</p><p>Mileage claimed ______</p><p>TOTAL CLAIMED £______</p><p> Miscellaneous Expenses Grant **</p><p>Salary of old appointment £______</p><p>Married YES/NO</p><p>Number of children ______</p><p>Ages at time of appointment ______</p><p>( A child for this purpose is a member of the household aged 4 years or over and receiving full-time education, or under 17 years of age and serving a full-time apprenticeship who has to go to another school or place of apprenticeship because of the move.)</p><p>TOTAL CLAIMED £______</p><p>* Please attach receipted accounts ** Please attach a statement of the miscellaneous expenses for which this miscellaneous Expenses grant is being claimed. APPLICATION FOR EXCESS RENT ALLOWANCE</p><p> NAME</p><p> GRADE</p><p> STATUS</p><p> DATE OF NEW APPOINTMENT</p><p> LONDON WEIGHTING</p><p> PERCENTAGE OF REMOVAL EXPENSES PAYABLE</p><p> ACCOMODATION IN NEW AREA:</p><p>Date of occupation ______</p><p>Furnished or unfurnished ______</p><p>Buying Price ______</p><p>Annual ground rent and/or feu duty ______</p><p>Annual title payment ______</p><p>Annual Insurance of property ______</p><p> ACCOMODATION IN OLD AREA:</p><p>Owner occupier/Tenant ______</p><p>Furnished or Unfurnished ______</p><p>Selling Price ______</p><p>Annual ground rent and/or feu duty ______</p><p>Annual title payment ______</p><p>Annual Insurance of property ______</p>