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 : : : : .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. etc.) Particulars of Dependents: Name Age Relationship with Employee : : : : : : : : I hereby declare that the family members mentioned above are dependent on me. copies of tickets.

07. . Pirojsha Nagar. co. 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.LBS Marg. ltd.Mumbai-79 0 260 800 Claim (max...11 14. Godrej & Boyce Mfg. 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.00 Address stated on bill: Capgemini Consulting India Pvt.11 9769249135 / 93700 65487 Bill amount 325.00 1000.Plant5.07.TELEPHONE REIMBURSEMENT CLAIM FORM Name: Code: Date: Mahesh Garg 26426 14/7/2011 Cell phone Telephone Number: Bill date 04.Vikhroli(W). subject to overall limit of 80% of total bill amount. Ltd. 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.

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