REIMBURSEMENT CLAIM FORM

Name of the Employee: Sai Lakshmi Thota Project:

Employee Code: 321935 Project Code:

Approved by: varun Department:

Approver E-Code: 317639 Date:

Billable/Non -
Expense Category Detail of claim Bill No.
Billable (client)
A. Expenses part of CTC
Medical

Mobile

Internet/Broadband      

Petrol      

Driver      
LTA [Please submit LTA declaration form along with
this claim]
Sub Total (A)

B. Official Expenses

Project Party      

Hotel Bills

Local Conveyance

Local Conveyance

Relocation

Telephone - Official

Visa Fees

Wedding Gift Reimbursement

Domestic Travel (Please specify travel location and

travel period)
Others (Pls specify): Courier
Others (Pls specify):

Others (Pls specify):

Sub Total (B)

Total

Amount in Words: Two thousand and seven hundered rupees only

Approver Signature: Varun

Designation: Analyst

Notes:
1. Expense report received for the period of 1st to 15th will be paid by 22nd and 16th to 30th will be paid by 7th of next month.
2. All Expenses must be supported by original invoices. The expense report will not be accepted without the bills.
3. All expenses under section B are required to be approved by PM / BU Head / Department Head
4. Client's approval is mandatory if expenses is billable to the client.
#708 - BRA - Southeast - Phase I

708

OSM

20 October 2020

Bill Date Amount (Rs.)

 -

2,700
 8

2,700

Employee Signature: Lakshmi Thota