Date:.

Invoice / Claim Form for Group Swimming Lessons

Name Address Office Use Only Approved

Tel. No. Week No. Date Venue Mon Hours Tue Hours Wed Hours Thurs Hours Sat Hours Sun Hours Hourly Rate Total Hours Payment Due

Totals Example
Wee k Date Venue Mon Hours Tue Hours Wed Hours Thur Hours Sat Hours Sun Hours

16
Hourly Rate

10
Total Hours

160.00
Payment Due

23/6/05

RGS

12 Totals

4 4

48.00 48.00

Payment Procedure Please complete and return a Claim Form to the address above after lesson 5 and lesson 10. You should only claim for hours you have worked. If you required cover for any of your lessons, the Instructor covering the lesson must return a Claim Form. If claiming for lessons covered for another Instructor, please complete another Invoice/Claim Form adding clearly the name/names of Instructors you have covered lessons for. Failure to complete and return a Claim Form could result in delayed payment or loss of pay. Payment will be made to you promptly on receipt of a correctly completed Claim Form.

Signature:...................................................................