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CLAIM FORM FOR OPEN ACCESS FEES

Completion of this form is obligatory for all Wellcome Trust funded applications, otherwise researchers will be liable for payment.
Funds will only be released where the publisher’s scheme complies with the Wellcome Trust’s requirements.
If in doubt, please ask before submitting.
Please complete all sections of the form to ensure that claims are processed as quickly and efficiently as possible. 
Please return with copies of the requested documents to Melanie Bickerton/Kirsteen Watt, as directed below.

Claimant's Name
Email Address
School

The grant details listed below must have supported the work published:

Name of Wellcome Grant Holder(s)
Wellcome Grant Number
Grant Reference Number (University of Aberdeen)
Was the research also supported by another funder? If so,what was the division in funding? (eg – Wellcome Trust 60% : ARC 40%)	Yes / No
Do you have funding in your grant for this payment?	Yes / No
The University has a pre-paid subscription for BMC and researchers can request access to these funds, if their publication has been funded by the Wellcome Trust. See accompanying guidance notes and BMC web-site - http://www.biomedcentral.com/
Are you applying for a publication to be made open access via BMC?	Yes / No
FOR BMC PUBLICATIONS
Where do you intend to publish?
If you have any queries contact Melanie Bickerton – (m.bickerton@abdn.ac.uk)
REIMBURSEMENT TO RESEARCHERS FOR NON-BMC PUBLICATIONS
Journal Title
Author(s)
Please indicate if the Open Access fee has already been paid to the publisher?	Yes / No
If yes – please indicate:-
the amount already paid in GBP
whether paid from a University source or paid personally	University / Personal
the ledger code to be reimbursed
Please enter the UK PMC reference
Please confirm that you have forwarded or faxed copies of all the items listed below to Kirsteen Watt by marking the following check boxes:
Article - PDF or word document including the title page
Publisher’s invoice or request for payment  - showing publisher’s address and cost of open access fee.
Proof of payment
Please Note: For personal reimbursement, if application is approved, you will be asked to complete a personal expenses claim form.
If you have any queries please contact Kirsteen Watt  (k.m.watt@abdn.ac.uk)
A copy of your submission will be emailed to your PI for confirmation that all the information provided is correct and complies with Wellcome Trust policy.
PI's name
PI's email
Dated: 24/05/2012

College of Life Sciences and Medicine
University of Aberdeen · Polwarth Building · Foresterhill · Aberdeen · AB25 2ZD
Tel: + 44 (0) 1224 437944 · Fax: + 44 (0) 1224 437069 · Email: clsm@abdn.ac.uk