Harrington Bates Ltd

Please Complete this form and click on the submit button:
School:
Postcode:
Contact Name:
Telephone:
Fax:
E-Mail:

Staff Numbers (FTE)	Teachers:
	Support Staff :
	Other Staff :

Daily Benefit (e.g. Ł160 per day)	Teachers:
	Support Staff :
	Other Staff :
Excess Period
(The maximum number of days to be deducted from each claim - nil, 3, 5, 10, 15 or 20)
	Number of Days:

Past Claims
Details of all claims and absences in the past 3 years, after deducting the appropriate Waiting Period (as above) from each absence.
	Teachers	Support Staff
2005/2006
2006/2007
2007/2008

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