TRAVEL ACCOUNT SETTLEMENT FORM

Name: Travel From - To Date Departure Time Date Arrival Time Paid by Code: Designation A Travel Mode Fare Paid by B Lodging Bill. No Amount Paid by Grade: Department: C Boarding Bill No. Amount Incidental D E Local Conveyance Mode Amount No. Location: F Tips Amou nt Self No. of Days: Total A to F Credit Card Company Total

Total
Expenses Claimed for Rs. :________________Expenses Passed for Rs._____________________(Rupees in words)_____________________________________________________________________________________________________only Tour Advance Details Advance Received Total Expenses (II) Difference of (i) & (II) Amount due to Employee Amount due to Company Signature of the Employee Endorsement of the above by Admin. Approved by HOD Checked by (FIN) Passed by (FIN) Rs. 0 P. 0 0 Travel arranged by Admin. (to be filled by employee) YES NO NO

Lodging arranged by Admin. (to be filled by employee) YES

Note: Please mention Se if the expenses incurred by employee; CC, if by Credit Card and Co, if by the Company in the paid by column.

SPN JULY12

SPN JUNE12

SPN MAY12

SPN APRIL12