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[]
["UNIVERSITY OF EAST ANGLIA",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"FORM  UEA  8"]
["STUDENT EXPENSES CLAIM FORM"]
[]
[]
["(PLEASE COMPLETE IN BLOCK CAPITALS)"]
[]
["NAME"]
[]
["STUDENT No",null,null,null,null,null,null,null,null,null,null,null,null,"SCHOOL / YEAR"]
[]
["BANK DETAILS:"]
[]
["BANK NAME"]
[]
["BRANCH"]
[]
["SORT CODE",null,null,null,null,null,null,null,null,null,null,"ACCOUNT No:"]
[]
["JOURNEY DETAILS",null,null,null,null,null,null,null,null,null,null,null,"RAIL / BUS",null,null,null,null,null,"CAR OR OTHER VEHICLE",null,null,null,null,null,"AMOUNT"]
["DATE","TO",null,null,null,null,"FROM",null,null,null,null,null,"SINGLE  /  RETURN",null,null,"2nd       CLASS",null,null,"MILEAGE",null,null,"RATE",null,null,"£",null,"p"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["OTHER EXPENSES"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"TOTAL EXPENSES CLAIMED  £"]
[]
["I confirm that the above details are correct:"]
[]
[null,null,"Signed (Student)    ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date"]
[]
[null,null,"Authorised for payment by:  Signature     ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date"]
[]
[null,null,"Authorised by:  (Block Capitals)    "]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,"Account",null,null,"Chargecode",null,null,null,null,"£",null,null,null,"p"]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,"TOTAL:"]
[]
["Description (14 characters) to appear on Bank Statement"]