Other appendices

Statement of change of residence expenses

Items that must appear on the document(s) presented to the accountant (presentation in code form is excluded):

1. Identification of the agent

Specify:

- surname;

- first name;

- grade or post;

- index of remuneration or monthly remuneration base;

- marital status (single, married, partner in a PACS, cohabiting partner, widowed, divorced, legally separated).

2. Agent's rights

Indicate:

- date of entry into the local authority or state civil service;

- date of taking up the duties in the previous post;

- date of installation in the new post;

- municipality of the former administrative residence;

- address of the former family home;

- address of the new family home;

- effective date of the change of family residence;

- reference to the decision giving rise to the entitlement, with article and paragraph of decree no. 90-437 of 28 May 1990 as amended or decree no. 2001-654 of 19 July 2001 which is being applied;

- whether it concerns the reconciliation of spouses or PACS partners;

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- where applicable, information enabling the length of service condition to be assessed as having been met;

- where applicable, that the employer of the agent's spouse, PACS partner or cohabiting partner does not pay for the agent's removal expenses.

3. Beneficiaries

3.1 Spouse, PACS partner or cohabitee

Specify:

- surname (and maiden name);

- first name;

- profession;

- if both spouses, civil solidarity pact partners or cohabitees are not civil servants that the personal resources of the spouse, civil solidarity pact partner or cohabitee do not exceed the minimum civil service salary, or that the total of the personal resources of the spouse, civil solidarity pact partner or cohabitee and the gross salary of the agent does not exceed three and a half times the minimum salary mentioned above.

3.2 Children of the couple, of the agent, of the spouse, PACS partner or cohabitee, foster children, dependent children within the meaning of the legislation on family benefits, disabled children within the meaning of Article 196 of the General Tax Code, habitually living under the agent's roof

Specify:

- surname;

- first name;

- date of birth ;

- any comments;

- where applicable, that the cost of transporting children and their furniture is not covered by the employer of the spouse, PACS partner or cohabitee.

3.3 Ascendants of the employee or spouse usually living under the employee's roof and not subject to personal income tax

Specify:

- surname;

- first name;

- any observations;

- where applicable, that expenses relating to ascendants are not covered by the employer of the spouse or partner in a PACS.

. 4. Detailed calculation of entitlements

4.1 Personal travel expenses

For journeys for which reimbursement of expenses is claimed, specify:

- the journey made;

- the mode of transport used or the nature of the vehicle used.

4.1.1 Use of public transport

Indicate the fare paid.

4.1.2 Use of a private vehicle

a) Use of a private land motor vehicle

Compensation paid on the basis of the cheapest public passenger transport fare:

Indicate the price of the mode of public transport used. Indicate the price of the mode of public transport chosen.

Compensation in the form of mileage allowances:

If using a private vehicle (car), indicate:

- the tax rating of the vehicle;

- the number of kilometres travelled since the beginning of the calendar year for service purposes;

- the number of kilometres travelled in respect of the journey for which compensation is requested;

- the applicable rate(s);

> the amount of mileage allowance claimed - the amount of the mileage allowance;

b) Use of a taxi, hire car or personal vehicle other than a motorised land vehicle

Indicate the amount of compensation.

c) Reimbursement of car park and motorway toll charges

Indicate amount paid. Indicate amount paid.

4.1.3 Total personal transport costs

Specify:

- the agent's total entitlement;

- the amount of any advances granted;

- the total sums due to the agent, after application, where applicable, of the 20% deduction (art. 10, 12 and 13-2nd paragraph of decree no. 2001-654 of 19 July 2001).

Flat-rate allowance for transporting furniture or luggage

Specify:

- weight of luggage (P);

- or volume of furniture (V);

- distance in kilometres between the old and new residence;

- calculation of allowance;

> amount of allowance - amount of the allowance;

- in the event of a change of residence between mainland France and Corsica or between mainland France and the coastal islands, amount of the additional allowance;

- total;

- the amount of any advances granted;

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- the amount to be paid to the agent, after application, where applicable, of the 20% deduction (articles 10, 12 and 13-2nd paragraph of decree no. 2001-654 of 19 July 2001).

5. Commitments of the agent

5.1. If the agent's family is already settled in the new family residence

The agent certifies that he/she has definitively relocated to his/her new personal residence with the members of his/her family for whom he/she is requesting payment of removal expenses;

5.2. If the family has not settled in the new family residence

Or the employee requests the lump-sum allowance for himself alone,

or Or he/she requests the flat-rate allowance for himself/herself and all the members of his/her family and, in this case, undertakes to produce to his/her manager within one year of the date of his/her change of administrative residence, under penalty of repayment to the Treasury of the sums unduly received, proof that all the members of his/her family taken into account for the calculation of the allowance have actually joined him/her in his/her new family residence during the nine months following his/her installation in his/her new duties.

6. Summary

Total the sums due to the agent.

7. Signatures to be entered on the expense claim (1)

a) The agent:

- certifies the accuracy of the information given on the expense claim;

- dates and signs the statement of costs.

b) The representative of the local body:

- certifies the accuracy of all the information given on the statement of expenses (marital status of the agent; entitlement of the spouse, PACS partner or cohabitee, children, ascendants, etc.);

dates and signs it.

c) The representative of the local body - date and sign.

(1) When the expense claim is dematerialised, the agent's validation of the reimbursement claim in the local authority's travel expense management software is equivalent to the agent's signature of the expense claim. By validating the claim, the employee certifies that the information on the expense claim is accurate. The signing of the corresponding mandate slip by the local authority or public institution is equivalent to signing the expense claim produced in XML format. This signature is equivalent to certification of all the information entered on the expense claim.

8. Comments

Agents will be reminded that the supporting documents in their possession must be submitted to their management department in support of the statement.