ABC Company

TRAVELLING EXPENSE STATEMENT / CLAIM

Name Period :
Employee Code : Head Quarters :
Designation :
Department : IT
Travel Mode of Fare
Departure Arrival Duration Travel
Date Time Place Date Time Place (Time)
I hereby certify that the above statement is true to the best of my knowledge and that the amount claimed is the
actual expense incurred by me for travelling in connection with official duty.

Name & Signature :

Recommendation by Branch / Dept. Head : Manager (Audit) :

Signature : Signature :

Passed for Rs…………………………..( Rupees ………………………………………………………………………………………………………………..only)

Date of Submission of Claim :
Claim No. :

If Own/Comp Lodging Dt. Total

Vehicle- Purpose of DA From To Lodg. Other
km covered Journey Charge Exp.
 Total
Advance
Taken
Balance

Approved by :
Signature :

only) Name :