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Wazir Advisors Pvt. Ltd.

REIMBURSMENT FORM
Date Of
Name: DURGESH SURYAWANSHI 15-09-2022
Submission:
Project Name: DDUGKY
Bhopal MP.
Remarks
S.No. Date Expense Head DESCRIPTION OF EXPENSE AMOUNT (Rs.)
If Any
Chhindwara To Isra Umariya Chourai Road 22 Km, 22Km+22 Km=
1 16-Sep-22 Mobilization Isra Umariya To Chhindwara 22 Km.22Km+22 Km= 154 44Km*3.5Rs/Km=
44Km*3.5Rs/Km=154Rs. 154Rs.
Ma Online & Stationary: PV Sample print 9 Pages
Printing and
2 17-Sep-22 9*5Rs/pages=45Rs. & ID card Q-Team 50 Rs=95 95 Bill Attached
stationary
Rs
Chhindwara To Mankadai (Mohokhed) Ready
candidate Councelling.( Candidate Moved on 18th 15km+15km=30
3 17-Sep-22 Mobilization Morning 4 Candidates) 15km . Return Mankadai to 105 Km*3.5rs/km=10
Chhindwara 15Km. 15km+15km=30 5Rs
Km*3.5rs/km=105Rs.

PV at Morning (Meeto) : Chhindwara To Reliance


5km+5km+5km+
Retails 5 Km. Reliance Retails Chhindwara 5 km.PV
5km
4 17-Sep-22 RO Travel at Evening (Meeto : Chhindwara To Reliance 70
=20Km*3.5Rs/Km
Retails 5 Km. Reliance Retails Chhindwara 5 km.
5km+5km+5km+5km =20Km*3.5Rs/Km=70 Rs =70 Rs

Madhur Courier Services: Invoices Courier ( 1-sep-


5 17-Sep-22 RO Travel 40 Bill Attached
22 To 15-sep-22 Reimbursment)
Candidate movement @ Morning : Cwa Railway
6Km+6Km=12Km
6 18-Sep-22 Mobilization Station 6km , Railway station to home 6Km. 42
*3Rs/Km=42Rs
6Km+6Km=12Km*3.5Rs/Km=42Rs
PV (AbhishekVerma) : Chhindwara To Sarra 7Km+7Km
7 18-Sep-22 RO Travel Imlikheda 7 Km. Sarra Imlikheda To Chhindwara 7 49 =14Km*3.5Rs/Km
Km. 7Km+7Km =14Km*3.5Rs/Km=49 Rs =49 Rs

Printing and PV Sample online Print , 2 Candidates 9 Pages


8 18-Sep-22 54 Bill Attached
stationary Each.18 Page*3Rs / Page=54Rs
PV (Parvati Uikey) @ Seoni: Chhindwara To Seoni
Reliance Mart Jabalpur Road To Candidate 78Km+78Km=15
9 18-Sep-22 RO Travel 546
Residiential 78 Km, Return Seoni To Chhindwara 78 6 Km*3.5Rs/Km=
Km. 78Km+78Km=156 Km*3.5Rs/Km=546Rs 546Rs
Printing and PV Sample online Print , 3 Candidates 9 Pages
10 19-Sep-22 81 Bill Attached
stationary Each.27 Page*3Rs / Page=81Rs
PV (Mamta & Mango): Chhindwara To nagpur Road
5Km+5Km=10Km
11 19-Sep-22 RO Travel Nera Jewan Jyoti Hospital 5 Km, Return 5Km. 35
*3.5Rs/km=35Rs.
5Km+5Km=10Km*3.5Rs/km=35Rs.
PV (Rajesh Verma) & DDU Mobilisation @ Chourai:
38Km+38Km=76
Chhindwara To Chourai Seoni Road 38 Km, Return
12 19-Sep-22 RO Travel 266 Km*3.5Rs/Km=
Chourai To Chhindwara 38 Km. 38Km+38Km=76
266Rs.
Km*3.5Rs/Km=266Rs.

13 19-Sep-22 Food 100 Bill Attached

PV (Rajesh Verma) @ Chand: Chhindwara To 33Km+33Km=66


14 20-Sep-22 RO Travel Chand 33 Km, Return Chand To Chhindwara 33 231 Km*3.5Rs/Km=
Km. 33Km+33Km=66 Km*3.5Rs/Km=231Rs. 231Rs.

15
16

17

18

19

Total Total 1868


I hereby certify that the sum claimed as above has actually been spent by me for official purpose, details
attached.

Department Head
Signature of Employee
154

35

105

40

42

49

81

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