Sending in your reimbursement and remuneration claim – declaration forms

Update 20/4/12

Updated EPS Release 2 Guidance can be found here:

EPS Release 2 Guidance

What is a submission document for?

Dispensing contractors must send in a declaration form, called a 'submission document', when they are making their monthly claims for reimbursement and remuneration.  There are different forms to use depending on what you are making a claim for, and whether you are a pharmacist, GP or dispensing appliance contractor.  Below is a table so you can check which form you should use. 

NHS Prescription Services sends you your submission document in advance for you to make your monthly claim.  Each FP34A, C, D and PD Submission document is personalised and has a barcode on it specific to each contractor, and for pharmacists, dispensing doctors and appliance contractors to each dispensing month.

Please make sure you fill in all the relevant areas on the form.

 Type of dispensing contractor  Type of item dispensed  Form to send  Form colour
 Appliance contractor  Medical appliance  FP34A  Green
 All dispensing contractors  Private controlled  FP34PCD  White
Dispensing doctor  Any item allowed on an FP10  FP34D Submission Document  Pink
Dispensing doctor High volume personally administered vaccine item   FP34D Appendix form (together with FP34D Submission Document)  Pink
 GP who is not a dispensing doctor  A personally administered item (such as a vitamin B12 injection)  FP34PD Submission  Peach
 GP who is not a dispensing doctor  High volume personally administered vaccine item  FP34PD Appendix form (together with the FP34PD Submission document)   Peach
 Pharmacists  Any allowed item on an FP10  FP34C Submission document  White


When to send them

Dispensing contractors should despatch their claims, appropriately sorted, to NHS Prescription Services, no later than the fifth day of the month following that in which the medicine was dispensed, except appliance contractors who should despatch theirs by the third day of the month.

High volume vaccines

High volume vaccines - FP34D appendix or FP34PD appendix (see above for which one you should use).  Please see the examples below to help you fill in the relevant form.

Example FP34D appendix form

Example FP34PD appendix form

Tips for completing appendix forms

Controlled drugs

Submission document for submitting controlled drugs through a private account.

Not got your form?

If you lose your form or do not get it before you have to send us your claim, please phone or email our helpdesk on 0300 330 1349 or   Never use a photocopy, or a copy from another dispensing contractor.


You will find information about payment arrangements on the page ‘Payment Schedules’.