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OVERTIME CLAIM FORM v1.4
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May 2022
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PLEASE SEE GUIDANCE NOTES FOR COMPLETION AND SUBMISSION
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Complete this form and return to the Employing Faculty / Directorate. NB: Failure to provide information in full, as appropriate will result
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in the form being returned to you and potentially not being paid until the following month.
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PLEASE ENSURE THAT YOUR BANK DETAILS ARE CORRECT AND UP TO DATE IN THE STAFF HR PORTAL
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 Overtime ReasonSelect from Dropdown Faculty / DirectorateSelect from Dropdown
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 Employee No:p00 Appointment ID-
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 Forename(s) Surname
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 If you have worked more than one work pattern during the period of overtime, please use separate claim forms.
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Current Work Pattern (e.g. 0900 - 1700)
Enter 'Y' against each day of your normal work pattern and the normal times in the fields beneath.
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MonTuesWedThursFriSatSun
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InOutInOutInOutInOutInOutIn OutInOut
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Faculty / Directorate
where O/T worked		Day
O/T worked		Date
O/T worked		Time From
(24hr - hh:mm)		Time To
(24hr - hh:mm)		Total O/T hours
for Day (decimal)
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Total O/T Hours0.00
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CLAIMANT ACCEPTANCE & DECLARATION
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I declare that the dates and overtime hours shown above were worked by me in person and I have read and understood the Guidance Notes.
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 Signature
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 Date
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FACULTY / DIRECTORATE USE - only enter the number of hours if more than one costing
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HoursAccountCost CentreActivity
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 AUTHORISING FACULTY / DIRECTORATE
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I certify and confirm that the hours worked are in accord with the contract for this appointment and the cost code is correct and complete.
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 Authorised Signatory (Budget Holder) Print Name
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 Faculty / Directorate Date
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SUBMIT ACCORDING TO YOUR FACULTY / DIRECTORATE DEADLINES
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