EXPENSES CLAIMS FORM

Name :
Month of :

MILEAGE
DATE CLAIM PARTICULARS FUEL FOOD HOTEL TOLL TICKET PARKING OTHERS TOTAL
KM RATE AMOUNT

TOTAL CLAIM
LESS ADVANCE (-)
AMOUNT OWING TO/BY SEJATI

--------------------------------- ----------------------------------- ---------------------------------- Date Paid

CLAIM BY VERIFIED BY APPROVED BY Cheque No.
DATE : DATE 2/8/2018
: DATE :