LEAVE TRAVEL ASSISTANCE CLAIM FORM

Name : Code : Date : Claim for the period Destination Leave Period Date of Journey Place From Place To Mode of Travel Amount claimed (to be supported by travel agent invoices, copies of tickets, etc.) Particulars of Dependents: Name Age Relationship with Employee : : : : : : : :

I hereby declare that the family members mentioned above are dependent on me. I also declare that I have not claimed non-taxable LTA (including any previous employers) more than once in the current block of 2002-2005.

Signature For Office Use: Amount opted for under flexiplan Amount for which claim is made Taxfree amount Taxable amount

: : : :

TELEPHONE REIMBURSEMENT CLAIM FORM

Name: Code: Date:

Mahesh Garg 26426

14/7/2011

Cell phone Telephone Number: Bill date 04.07.11 14.07.11 9769249135 / 93700 65487 Bill amount 325.00 1000.00

Address stated on bill:

Capgemini Consulting India Pvt. Ltd.,Plant5, Godrej & Boyce Mfg. co. ltd., Pirojsha Nagar,LBS Marg,Vikhroli(W),Mumbai-79 0 260 800

Claim (max. 80% of bill amount)

Total:

1060

Total amount claimed (land-line + cellphone)

1060

DECLARATION: I hereby declare that I am making claim only towards calls made for official purposes, subject to overall limit of 80% of total bill amount. I am submitting photocopies of phone-bills in case of landline and original bills in case of prepaid cards along with my claim and would retain the originals of landline bills and produce the same as and when required.

Signature NOTE: In case of change of residence please give written intimation to PRM-Payroll of change in phone number for which such reimbursements may be claimed.