Covid-19 Monthly Claim Form

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Please complete the following form to claim the number of sessions worked at our Covid-19 vaccination sites in the previous month. All claims must be submitted by the 4th of each month.

1 session = Either 1 AM or 1 PM session worked
All day = 2 sessions

Any queries, please email awcmodality.finance@nhs.net

Many thanks

Name *

What is the month you are claiming for? *

Email *

Phone number *

How many sessions have you worked in the previous month? *

Please list details of the sessions worked. For example: dd/mm/yy AM session or dd/mm/yy All Day *

Please include any other relevant information:

Thank You

Thank you for taking the time to submit your claim.

Submit

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