TRAVELLING EXPENSE STATEMENT

Name :__________________________________ H.Q._________________Mth:__________

(IN BLOCK LETTERS)

Designation : _________________________EMP. CODE____________Date :_____________

Work Allowance
Total Total Coverage Approved
DT Market Covered Drs Chem
Fare Rs. EX-HQ Tour
Called Called From To HQ Rs.
Rs. Rs.
1 HOSADURGA 7 7 DVG HDURGA
2 HIRIYUR 8 8 DVG HIRIYUR
3 CHITRADURGA 9 9 DVG CTR
4 ITAGI / HALAGERI / HAUNSBHAVI 8 8 DVG HAUNSBHAVI
5 RANEBENNUR/ HONNATI 8 8 DVG HONNATTI
6 BYADGI 7 7 DVG BYADGI
7 SUNDAY
8 HOLALU / HALUVAGALU 7 7 DVG HOLALU
9 RATTIHALLI / MASUR 8 8 DVG MASUR
10 DAVANGERE 3 3 DVG
11 DAVANGERE 8 8 DVG
12 DAVANGERE 9 9 DVG
13 BYADGI 6 6 DVG BYADGI
14 SUNDAY
15 HOLIDAY
16 HIRIYUR 9 9 DVG HIRIYUR
17 CHITRADURGA 11 11 DVG CTR
18 ITAGI / HALAGERI / HAUNSBHAVI 8 8 DVG HAUNSBHAVI
19 RANEBENNUR/ HONNATI 9 9 DVG HONNATTI
20 BYADGI 7 7 DVG BYADGI
21 SUNDAY
22 LEAVE
23 HOLALU / HALUVAGALU 7 7 DVG HOLALU
24 RATTIHALLI / MASUR 8 8 DVG MASUR
25 DAVANGERE 10 10 DVG
26 DAVANGERE 10 10 DVG
27 DAVANGERE 8 8 DVG
28 SUNDAY
29 DAVANGERE 6 6 DVG
30 CHITRADURGA 10 10 DVG CTR
31 DAVANGERE 6 6 DVG
TOTAL
SIGNATURE DATE : _______________ a.       Courier__________
(MANDOTORY)_____________________ b.      Printing, Stationery
Checked & approved by c.       Mobile __________
ABM/RBM/DSM/SM_______________Date:_________________ d.      Sample Clearing___
NAME :________________________________________________ e.      Misc_____________

DEGS :________________________________________________
GRAND TOTAL
For Instructions please refer overleaf.
1st Copy – HEAD OFFICE (WITH ALL ORGINAL SUPPORTING VOUCHER) 2nd Copy – ABM, 3rd Copy – RBM/SrRBM,
should reach HO by 7th of the Month.
 H. O. : # 604/2/605 - 5th
Main - 14th Cross MC
Layout - Vijay Nagar -
Banglore - 5600041

Lodging/ Remarks
Boarding Rs.
Rs. Total
Rs.

No.of Bills
urier_____________________________
ting, Stationery & Xerox____________
bile _____________________________
mple Clearing_____________________
c________________________________

GRAND TOTAL

y – RBM/SrRBM, 4th Copy – Self,

 BAGALKOT DATE OF VISIT
SL
No NAME OF THE Drs, Qualification Plase & Cell N MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB
SHANKAR S PATIL DCH BGK
1
B H JAMKHANDI ENT BGK
2
R R SHETTER ENT BGK
3
G V HOILGOL MBBS
4
JYOTHIBA R JADHAV
5
SUDHEER J JADHAV
6
VIJAY KANTHI MS
7
VASUMATI KANTHI DCH
8
ANITHA KANTHI DGO
9
S M INAMDAR DTCD
10 (SHANTI HOSPITAL)
AMARESH DEGINAL MBBS DNB Neuro Surg
11 (SHANTI HOSPITAL)
R T PATIL MD (Ped)
12 (SHANTI HOSPITAL)
SUNIL J PATIL MD Ped
13 (SHANTI HOSPITAL)
ARTHI SRIKANT SAKA MD DGO
14 (SHANTI HOSPITAL)
L L PUJARI MD OBG
15 (SHANTI HOSPITAL)
S S INAMDAR MBBS DOMS (EYE)
16 (SHANTI HOSPITAL)

Page 3
 RAMESH HATTI MS Mch
17 (SHANTI HOSPITAL)
GOPAL B BAJAJ MD (Med)
18 SPANDANA HOSPITAL
GAURA G VASANAD DGO
19 SPANDANA HOSPITAL
JAYASHRI S TELSANG MD GO
20 TELSANG HOSPITAL
SUNIL R TELKAR MS GEN
21 TELSANG HOSPITAL
VILASWATI S KANTHI MBBS DCH
22 TELSANG HOSPITAL
G B DOODAMANI MD
23 CARDIOLOGIST & DIABETOLOGIST
(TELSANG HOSP)
SUMANGLA M DADDENNAWAR MD DGO
24 DADDENNAWAR HOSPITAL
ARCHANA V DADDENNAWAR MBBS MS GO
25 DADDENNAWAR HOSPITAL
SHASHIDAR P KHANAPUR MBBS MD (INT
26 MEDICINE) DADDENNAWAR HOSPITAL
M S DADDENNAWAR D.Ortho (GEN)
27 DADDENNAWAR HOSPITAL
CHANDRESHEKAR S HIREMATH MBBS MS ENT
28 DADDENNAWAR HOSPITAL
VIKAS M DADDENNAWAR MS (GEN)
29 DADDENNAWAR HOSPITAL
N B SANAKAL MBBS DN B.ORTHO D.ORTHO
30 DADDENNAWAR HOSPITAL
V S SUBHANI DCH DNB
31 KERODI HOSPITAL
ANUSUIYA B KERODI MBBS DGO
32 KERODI HOSPITAL
PRIYADERSHINI NARA MS OBG
33 KERODI HOSPITAL

Page 4
 B H KERODI MS
34 KERODI HOSPITAL
SUNITHA H KERODI
35 KERODI HOSPITAL
H F YOGAPPANAWAR MD PHY
36 YOGAPPANAWAR HOSPITAL
SANGAMESH M MALAJI MD
37 BM HOSPITAL
RAMESH R POLE MD PED
38 BM HOSPITAL
GIRISH SANGAM MD INT MED
39 DHANUSH HOSPITAL
RAGAVENDER N VENKI MD PED
40 DHANUSH HOSPITAL
KELUDEEPPA TALAWAR MD PED
41 DHANUSH HOSPITAL
BHAGYA D PATIL DGO
42 DHANUSH HOSPITAL
B S ANAND DVD BGK
43
SHIVANAND BADADESAYI MBBS BGK
44
B C PATIL DCH BGK
45
PRAKASH LAJAMI MBBS BGK
46
SWATHI LAJAMI MBBS BGK
47
KIRAN KALABURGI ENT
48 KALABURGI HOSPITAL
SMITHA KALABURGI DGO
49 KALABURGI HOSPITAL
R V JOSHI MBBS
50

Page 5
 S V PANDARE MBBS
51
J DESHPANDE MBBS
52
S B CIMANAKATHI ORTHO
53
P M PRABUSVAMIMAT MD
54

55

56

57

58

59

60

61

62

63

64

65

66
SL
No
ILKAL MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB
GURURAJ MALAGI DCH
1

Page 6
 SMT JANAKI G MALAGI
2
PAVANKUMAR K DARAK MBBS DCH
3
MOHAN P KAMBAD MBBS DCH
4
ARUNA K AKKI MBBS DGO
5
SMT ANITA M AKKI MBBS DGO
6
R S AKKI ORTHO
7
MAHANTESH K AKKI MBBS MS ORTHO
8
MAHALINGAPPA GOGADASHETTI DCH
9
R V GOGADASHETTI DCH
10
B H JAHAGIRDAR BAMS GP
11
N Y PATTAR BAMS GP
12
SAVITHA KATHARI
13
S M KADDAPATTI DGO
14
M S KADDAPATTI MD
15
M D MALAGI MD
16
J B BAIRAGOUDA ORTHO
17

18

19
Page 7
19

20

21

22
DATE OF VISIT
SL
No
BADAMI MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB
KIRANKUMAR S KULGERI MBBS PED MD
1 SRI VENKATESHWAR HOSPITAL
MONAJ VERKERI MBBS DNB
2 SRI VENKATESHWAR HOSPITAL
SMT PRIYADERSHANI S UNGALVAT
3 SRI VENKATESHWAR HOSPITAL
SURESH M UNGALVAT GENERAL PHY
4 SRI VENKATESHWAR HOSPITAL
GIRIJA S BOMNAGOUD
5
B N GONGAL BAMS
6
V N NILUGAL BAMS
7
SMT SUVERNS V NILUGAL BAMS
8
MARUTI B TALWAR MD PED
9
DATTATHRY D JALDE DGO
10
B S CHOUDHRI D.ORTHO DNB
11
MANJUNATH BAMS
12

RAGU HASATAKAR BAMS

13 Page 8
 RAGU HASATAKAR BAMS
13
RAGAVENDRA KARADIGUDDA BAMS
14
SHOBHA KYALKUND DGO
15
G N BANGAL BAMS
16
SHIVU MALAWAD BAMS
17
SURESH JANALI ORTHO
18
C S HIREMATA BAMS
19
SATISH KATTIMANI BAMS
20

21

22

23

24

25
DATE OF VISIT
SL
No
BILAGI MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB
DAYANAND P HIREMATH BAMS
1
V S KATTIMANI MBBS
2
S V KATTIMANI MBBS
3

SUDHA BASAWARAJ BAMS

4
Page 9
 SUDHA BASAWARAJ BAMS
4
VENKATESH P NAGNOOR MS
5
MOHAN M CHATTER BAMS DAC
6
MRS PARVATI M CHATTER
7
RAGHVENDRA G MALOJI BAMS
8
PRASHANT S BANHATTI BAMS
9
SANTOSH VADAI
10
G B KUMBAR BAMS D.PHARMA
11
JAGADISH KOLI
12
B D DHANRAJ
13
SARAFULLA KHAN INAMADAR
14
S D KARRENNAWAZ
15
JAYASHREE PATIL
16
P S PATTED
17
B R NAIKAR
18
P H BANHATTI
19

20

21
Page 10
22

23

24

25

26

DATE OF VISIT
SL
No
LOKAPUR MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB
SURESH T MULLUR MBBS DCH
1
S F CHAVARAD MBBS RTD DHO
2
M D JADAGOUDA BAMS DMLT
3
SHARATHANAND SHETTI BAMS
4
PREETHI SHETTER
5
DEEPAK V BARADDI BAMS CCH CGO
6
SRINIVAS KANAKREDDY BAMS
7

10

Page 11
11

12
DATE OF VISIT
SL
No
MAHALINGAPUR MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB
SRIKANTH B ARISINGUDI MBBS DCH
1
ANUPAMA S ARISINGUDI MBBS DGO
2
M B PUJARI BEMS
3
HARSHITA A KANKREDDI MD PED
4
ANAND B KANAKREDDI MBBS DCH
5
RAJENDRA B PATIL MD
6
USHA R PATIL BAMS
7
VASANT G BEERANGADDI BAMS
8
SMT KAVYA V BEERANGADDI BAMS
9
V S MANDAPUR GENERAL PHY
10
PRABHUDEV C ANDANI MS GEN SURG DLAP
11
SMT VEENA P ANDANI MS OBG
12
B D SORAGANVI MBBS
13

MANJUNATH CHANNAL BAMS PED

14

Page 12
 SURESH M CHANNAL BGO
15
B D BALIGIDAD MS
16
VIJAY HANCHINAL MD
17 CARDIOLOGIST & DIABETOLOGIST
SANDEEP KANAKREDDI ORTHO
18
AJITA KANAREDDI MD
19
USHA BELAGALI DGO
20
A C DILIMANI BAMS
21
V A DILIMANI BAMS
22
S BILGI BAMS
23
R A MURAGUOD BAMS
24

25

26

27

28

29

DATE OF VISIT
SL
No
ALMATTI MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB

1
Page 13
 2

10

11

12

13

14

15

DATE OF VISIT
SL
No MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB

Page 14
3

10

11

12

Page 15