Payment Request Form

CHALLENGE NUMBER :	Click here to enter text.
NAME OF CHARITY :	Click here to enter text.
DATE OF CHALLENGE :	Click here to enter a date.

To (your ZCT contact):	Choose an item.	From (your name):	Click here to enter text.
Department:	Zurich Community Trust Unity Place, Swindon	Your Location:	Click here to enter text.
Date:	Click here to enter a date.
Payment Method	Bank Transfer Only	Your Phone Number:	Click here to enter text.

Details Needed for Bank Transfer:	Account Name (Full Name):	Click here to enter text.
Account Number:	Click here to enter text.
Sort Code (000000): Please complete without the hyphens, spaces etc Thank you.
Total Payment Amount:	£
If the receipt amount is different to the amount you are claiming, please explain why?

CHECKLIST BEFORE SUBMITTING

Copy in a second person from your team on the email for audit purposes

Attach proof of payment documentation, not orders

Now please email this completed form to your ZCT contact listed below:

ZCT Use only
LOCATION	ZCT ADMINISTRATOR
Swindon & Cheltenham (including CAPITA)	Marie Jones	6595910003 7521100001	ZC-CHAL SW/CH GB0I7037/65
Bristol, Cardiff & Chipping Norton	6595910003 7521100001	ZC CHAL-OTH GB0I7066
Whiteley & Farnborough (Hampshire)	Cheryl Evans	6595910003 7521100001	ZC-CHAL HAM GB0I7080
Belfast, Birmingham, Chichester, Croydon, Glasgow, Leeds, London, Manchester & Newcastle	6595910003 7521100001	ZC CHAL-OTH GB0I7066

Don’t forget to record your volunteering hours on MyImpact for both personal and business time used for your challenge. Your team leader will also be required to collate this information and feed it back to us in your post-challenge survey.