VAATSALYA HEALTHCARE SOLUTIONS PRIVATE LIMITED

TOUR CLAIM FORM

Name : Pradeep kumar Title/Desig.: Site Engineer Dept. : Project Team Emp. Code :
Purpose of Trip: preparing drawings and estimate
for up coming project Location:

(A) TRAVEL - AIR / TRAIN / BUS FARE :

Departure Arrival
Date From To Date From To Mode Class Amount
11/12/2010 banglaore mysore bus volvo 230
26-12-10 bijapur hulbi bus semi dlx 146
26-12-10 hulbi mysore train genral 105
29-12-10 mysore mandya bus 31
29-12-11 mandya mysore bus 31
TOTAL (A) 543
(B) CONVEYANCE CHARGES :
Date Place Mode of Conv KM Amount Remarks
From To

TOTAL (B)
(C) BOARDING / LODGING :
Date No. of Amount for Self
Invoice No Amount for Hotel Accommodation
From To Days Accommodation
14-12-10 21-12-10 7 3 4795 less food bill
23-12-10 23-10-10 1 1308 320
23-12-10 26-12-10 3 1634 1050
TOTAL (C) 6165
(D) FOOD EXPENSES : -
Date Bill Number B/fast/Lunch/Dinner Amount Remarks

26-12-10 to 10-1-11= 15 days x 300 Rs 4500

TOTAL (D) 4500

(E) MISCELLANEOUS EXPENSES incl. D.A / TIPS…ETC
Date Particulars (including explanation) Amount
3/1/2011 airtel bill ( whole amount to be paid ) roamming ( ap ) 880
A3 print ( vizinagaram ) 145
15 meter Tape 180
TOTAL (E) 1,205.00
GRAND TOTAL (A+B+C+D+E) 12,413.00
LESS ADVANCE : 0
BALANCE CLAIM / REFUND 12,413.00

Sign of Employee : Sign & Name of HOD :

Date :03/01/11 Date :
 390

mysore

Remarks

Remarks

Amount for Self

ccommodation
less food bill

Remarks

Amount
880
145
180
1,205.00
12,413.00
0
12,413.00