FFLM Examinations Invoice Form (OSCEs Only)

About You

Your Name(Required)

First Name Surname

Your Address(Required)

Address Line 1 Address Line 2 Town/City Postcode

How Can We Reach You?

Please provide us with your email address and phone number in case we need to contact you with any queries regarding your form.

Your Email Address(Required)

Your Role(Required)

Actor

Examiner

Invigilator

Moulage Artist

Your Claim

About Your Claim (Actor)

Date Worked(Required)

Start Time(Required)

:

End Time(Required)

:

Exam Type(Required)

What are you claiming for? (Actor)(Required)

Rehearsal 1 Session: Half Day (Actor)

Rehearsal 2 Sessions: Full Day (Actor)

Examination 1 Session: Half Day (Actor)

Examination 2 Sessions: Half Day (Actor)

Examination 1 Session (Half Day Actor £140)(Required)

Rehearsal 1 Session (Half Day Actor £70)(Required)

Examination 2 Sessions (Full Day Actor £280)(Required)

Rehearsal 2 Sessions (Full Day Actor £140)(Required)

Claim Total (Actor)

About Your Claim (Invigilator)

Date Worked(Required)

Start Time(Required)

:

End Time(Required)

:

Exam Type(Required)

What are you claiming for? (Invigilator)(Required)

1 Session: Half Day (Invigilator)

2 Sessions: Full Day (Invigilator)

1 Session (Half Day Invigilator £137.50)(Required)

2 Sessions (Full Day Invigilator £275)(Required)

Claim Total (Invigilator)

About Your Claim (Moulage Artist)

Date Worked(Required)

Start Time(Required)

:

End Time(Required)

:

Exam Type(Required)

What are you claiming for? (Moulage Artist)(Required)

1 Session: Half Day (Moulage Artist)

2 Sessions: Full Day (Moulage Artist)

1 Session (Half Day £120)(Required)

2 Sessions (Full Day £240)(Required)

Claim Total (Moulage Artist)

About Your Claim (Examiner)

Date Worked(Required)

Start Time(Required)

:

End Time(Required)

:

Exam Type(Required)

What are you claiming for? (Examiner)(Required)

Examination - 1 Session: Half Day (Examiner)

Examination - 2 Sessions: Full Day (Examiner)

Rehearsal - 1 Session: Half Day (Examiner)

Rehearsal - 2 Sessions: Full Day (Examiner)

Examination - 1 Session (Half-Day £250)(Required)

Rehearsal - 1 Session (Half-Day £200)(Required)

Examination - 2 Sessions (Full Day £500)(Required)

Rehearsal - 2 Sessions (Full Day £400)(Required)

Claim Total (Examiner)

Lunch

You can claim up to £10 with a receipt.

Would you like to claim for lunch?(Required)

Claim Amount(Required)

Please enter a number from 0.01 to 10.

Please upload a copy of your receipt(Required)

Drop files here or

Max. file size: 16 MB.

Overall Value of Claim

Your Payment Details

Bank Name(Required)

Account Name(Required)

This is the name shown on the account

Sort Code(Required)

Account Number(Required)

Consent

Date(Required)

Additional Information

Additional Information (optional)

Please use this field if you have any additional information you would like us to know about.