COMPANY LIMITED

BRANCH OFFICE

CLAIM FOR REIMBURSEMENT OF MOTOR CAR RUNNING EXPENSES

FOR THE MONTH OF APRIL 2010

Name of the Officer:

Car No. Date of Purchase: Meter Reading at opening of the month: Meter Reading at close of the month: 1 100

Designation: Place of Posting:

Branch Manager
99 0

Running during the month Petrol charged for TE bills for the month

A. RUNNING EXPENSES:
Date of Purchase Cash/Memo Number Name of the Dealer

Qty. Litres.

Cost Rs. Ps.

Allowable Rs. Ps.

B. SERVICE CHARGES:
Cost Rs. Ps. (cleaning charges) 200.00 Less: Petrol Chargeable for TE Bills 0 #DIV/0! Enclosures: PETROL BILLS TOTALS 0.00 #DIV/0! PREVIOUS REIMBURSEMENT PARTICULARS IN THE PRESENT QUARTER TOTAL REIMBURSEMENT (A+B) MONTH QUANTITY AMOUNT Date Cash/Memo Number Name of the Dealer Allowable Rs. Ps.

TOTAL

NAME: DATE:

XYZ
DESIGNATION

FOR OFFICE USE:

AMOUNT PAID AMOUNT Rs.

Passed for payment for Rs.____

DATE: Checked by

authorised official