SC 02

/ AGREEMENT FOR AD HOC SERVICES or
PATIENT & PUBLIC INVOLVEMENT IN RESEARCH
Between: / The University of Sheffield
[Department / Faculty / School] / (“The University”)
and
Name / [Title / first and last names] / (“The Service Provider”
Address / [Full postal address and postcode]
Tel No. / [0114 2XXXXXX]
Email Address
ACTIVITY / [Brief title e.g. Attendance at Panel Meetings / Translation Services] / (“The Services”)

The Service Provider has agreed to assist the University by providing the Services.

  1. The Services to be provided are agreed as follows but may be varied from time to time by agreement between the Service Provider and the University.

[DELETE AND ADD DETAILS: Describe the planned activities – e.g. Expected number of panel meetings to be attended per annum; describe the contribution expected; include any specific points you need to be acknowledged in the agreement as part of the Service.]

CONFIRMATION OF ATTENDANCE OR SERVICES

  1. [Name of Department Member of Staff confirming attendance or the services have been deliveredetc.]will confirm the Service Providerhas delivered the Services detailed above.

PAYMENT AND CONTRIBUTION TO TRAVEL COSTS

  1. The Service Provider will receive a Payment of[detail the Payment due e.g. agreed rate per page reviewed / attendance per Panel Meeting / simple sum for the Services / describe the activities and meetings to be attended etc.][plusa contribution to travel expenses of [detail rate of contribution for travel within / outside Sheffield] / [Reimbursement of actual travel expenses subject to original receipts being provided.]

PAYMENT

  1. Payment will be made for any part of the Services delivered but Payment will not be made for any part of the Services not delivered as described in this agreement.
  1. Payment will be made [by transfer to the Service Provider’s personal bank account / Cash Payment] following confirmation that the Services have been delivered and the amount of the Payment and travel contributions due by [name of authorising staff member at 2 above.]
  1. Payment to the Service Provider from the University will be authorised by submission of a Short Contract Payment Claim form (copy attached) completed and signed by the Service Provider and [name of authorising staff member at 2 above] on behalf of the University.
  1. Bank details of the Service Provider are to be entered in full below on this agreement. If these details change before payment is made the Service Provider can update the details by completing a Change of Bank Details Form to be attached to the Short Contract Payment Form to support payment.

RELATIONSHIP BETWEEN THE UNIVERSITY AND THE PARTICIPATOR

  1. The University does not regard the Service Provider as an employee of the University nor as a worker and the Payment made to the Service Provider for the Servicesis not made with respect to an employment relationship with the University.
  1. The Service Provider is personally responsible for declaring the Payment and contribution to travel expenses received for providing the Servicesas earnings to HM Revenue & Customs under Self-Assessment and the University will not deduct income taxes from the Payment or travel contribution.

SIGNED FOR AND ON BEHALF OF THE UNIVERSITY
The signatory for the University confirms they have authority to enter into this agreement on behalf of the University.
PRINT NAME / [Name of authorising University staff member]
POSITION
DATE
SIGNED BY THE PARTICIPATOR
I acknowledge receipt of a copy of this agreement and accept its terms.
NAME
DATE
Agreement reference / [Reference must be allocated by Tax or Expenses Teams. Payment will not be made without this reference.]

BANK ACCOUNT INFORMATION SECTION – CHOOSE ONE OPTION ONLY

Option 1 - Payment to UK Bank or Building Society
Name(s) of Account Holder(s):
Name of your Bank or Building Society:
Address of your Bank or Building Society
Branch Sort Code: / - / - / Account Number:
Roll Number
(Building Society):
Option 2 - Payment to an Overseas Bank Account (see guidance note)
Beneficiary Bank Details
Name(s) of Account Holder(s):
Name of your Bank:
Address of your Bank:
Account Number: / Account Currency:
Bank Code Number: / SWIFT/BIC No:

(E.g. ABA Routing code, Transit Number, BSB Code):

IBAN Number
(Compulsoryfor EU Bank Accounts)
Intermediary/Correspondent Bank Details (if applicable)
Name of Bank: / SWIFT/BIC No:
Account Number:

Any additional information you wish to provide to ensure payment reaches you correctly:

Please sign and date to confirm account details provided in the chosen option above are correct

Signature of claimant / Date

GUIDANCE NOTES RELATING TO OVERSEAS BANK ACCOUNTS

  1. OVERSEAS BANK INFORMATION: For payments to be made to a Non UK bank account all fields in Option 2 must be completed. If you are not clear about the information requested please contact your bank for the correct details to ensure that payment reaches you.

a)Beneficiary bank account: This is the bank account that will receive the payment. (This must be a personal bank account bearing your name. If you have provided the Service on behalf of your employer please speak to your University contact on how Payment should be made direct to your employer.)

b)Intermediary/Correspondent bank account: If payment has to be made to another bank before it reaches the beneficiary bank account this is called an “intermediary bank” and is usually only required if your bank is unable to receive payments directly from a UK bank. Your bank will provide this information if required.

  1. BANK CHARGES:Please note that your bank may charge you for receiving international payments into your account and as a result you may receive less than the full amount you have claimed on this form.

a)The University will pay charges made by its own bank to send the payment to you but is not liable to pay charges made by your bank or intermediary bank to you personally.

b)If the bank details provided by you are incorrect and a payment made by the University to your bank account is rejected and the University is charged for the rejection, it reserves the right to recover such charges from any amount owed to you.

SC 02 Template Ad Hoc Service Contract 1703161