REIMBURSEMENT CLAIM FORM

Name of the Employee: Project:

Employee Code: Project Code:

Approved by: Department:

Approver E-Code: Date:

Billable/Non -
Expense Category Detail of claim Bill No. Bill Date Amount (Rs.)
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):

Others (Pls specify):

Others (Pls specify):

Sub Total (B)

Total

Amount in Words:

Approver Signature: Employee Signature:

Designation:
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.