You are on page 1of 1

Financial Objects Software (India) Pvt.

Limited
Car Fuel & Maintenance Claim Voucher

Name: Indrajit Dutta


Employee No.: 5924
Designation / Grade: Senior Business Analyst/6
Car Regn. No.: KA-05 EC 4671 (Car RC book copy to be attached)
Maximum eligibility per quarter: INR 9000.00
Details to reimbursement claimed

Sl.No. Bill Date Bill No. Supplier Name & Amount


Nature of (Rs.)
Expenses
1 25/10/2010 53732 Ideal Service Stn 2338
2 5/11/2010 12277 Ideal Service Stn 500
3 14/11/2010 0161 Sri Satya Sai 2360
Keerthi

Declaration:

I, Indrajit Dutta, do hereby declare that the above fuel/Car


maintenance expenses were incurred by me, while performing my
duties for Official / Business Purposes only.
I, further declare that the above information and Statement are
True to the best of my Knowledge and Belief.

Place: Bangalore
Date: 19/11/2010
………………………………
Signature of the Employee

You might also like