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<img src="https://christchurchhealthcentre.co.uk/wp-content/uploads/2020/06/christ-church-health-centre.svg" alt="Christchurch Health Centre" style="max-width: 300px;" />

Independent Prescriber Weekly Timesheet

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Independent Prescriber Weekly Timesheet

Full Name/Company Name *

Email

Week Commencing

Week begins on a Monday

Monday hours

Tuesday hours

Wednesday hours

Thursday hours

Friday hours

Saturday hours

Sunday hours

Total Weekly Hours

Hourly Rate

Total Weekly Pay

Sort Code *

Account Number *

Declaration *

I accept that this is a locum arrangement and that it is my responsibility to pay any Income Tax or National Insurance that may be due on these earnings. I agree that Christchurch Health Centre bears no responsibility in this matter.

Signature

If you are human, leave this field blank.

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