Reimbursement of Mobile Set Allowance Form

User Name :
Designation :
Department/ Function :
Company

Category A B C D E F G H I

Functional Allowance BDT___________________

(Only for Functional Head)
Total Amount ___________________

Mobile Set Details

Brand Model
Apple
Nokia
Microsoft IMEI Number
Samsung
LG
Sony
Huawei
Lenovo
Walton
Symphony
HTC
Oppo

Previous Phone Details :

Model : _________________ Last Issue Date : _____________________

Return to Store : YES NO

Clearance from IT : _____________________________________________________

Recommended by Certified by Approved by HOHR

User Signature
PSHR Functional Head &CC

N.B : Mandatory Required Documents

1. Original Bill/Money Receipt/Cash Memo/Invoice on the name of the user
2. Photocopy of the warranty card
3. Approval of IT Requisition