Claims must be completed within one calendar month, following the claim period, unless otherwise instructed on the Mutual Fund Website. Please fill out all applicable fields - also when clicking Submit, you will receive a Transaction Reference Number. Please make a note of this, as it will be required if you have any queries with your claim. Need Help? Read the Mutual Fund online claim form instructions. You should receive a response notification sent back to the school within 5 working days to confirm receipt of your claim via the Anycomms System. If you do not receive this notification please contact the Mutual Fund Team via email: email@example.com or phone 01392 382359. For more information about the Mutual Fund and what happens after you have submit a claim, please read the FAQs on the Mutual Fund Webpage School Details * School DFE Number Enter the DCSF number excluding the 878. * School Name * School Type Special Primary Secondary * Claim Type Continuous Phased Return * Claim Role Type -- Please Select -- Teacher Non-Teacher (Administrator) Non-Teacher (Teaching Assistant) Non-Teacher (Nursery Nurse) Non-Teacher (Residential) Non-Teacher (Technician or Resource) Non-Teacher (Premises) Non-Teacher (Catering) Non-Teacher (Meal Time Assistant) * Claim Month -- Please Select -- January February March April May June July August September October November December * Claim Year -- Please Select -- 2021-22 Staff Details * Title * First Name * Last Name * Nature of Absence -- Please Select -- Anxiety Arthritis/Rheumatism Blood Condition Broken Bone Cancer Carpal Tunnel Covid-19 - Self Isolation Covid-19 - Shielding Covid-19 - Positive Case Covid-19 - Long Covid Symptoms Depression Flu Gynaecological Heart Problems High Blood Pressure Infection Operation/Surgery Paternity Leave Pelvic Girdle Disfunction Pneumonia Psychological Skin Disorder Stress Suspension Tumor Vasovagal Episodes Other Other Absence If other was selected, please state the nature of the absence. * Pay Factor Rate -- Please Select -- 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 * Claim Percentage Deduct any hours worked remotely as a percentage from the total claimed. Authorisation * I certify that the above is an accurate record of teacher/non-teacher absence for the period shown. I claim reimbursement in accordance with the SMF scheme. I understand that if an over-claim is made this may be subsequently adjusted. Confirm * Certified By Please provide your name. * Date Certified Email Address On submission, a copy of the form will be emailed to this address.