ADDRESSHEALTH SOLUTIONS INDIA PRIVATE LIMITED

LOCAL TRAVEL CLAIM FORM

Name : RADHIKA.S.RAO
Designation: Manager,Operations & Mental Health Program, Health Education
Department : HEALTH EDUCATION
Your Present Home Addresses:NO11,6TH CROSS,9TH MAIN,KUVEMPU ROAD, CHIKKALASANDRA, BANGALORE560061.
Travel Policy: Rs.5/per KM -Two Wheeler,Rs. 20/ Per KM - 4 Wheeler,For other mode of tranportation it is at Actual can be Claimed supported with original bills
Food Policy: Upto Rs. 120/- Can be claimed supported with original food Bills

(A) LOCAL CONVEYANCE :

Date Place Invoice No Mode of Travel - 2wheeler/car/taxi/auto Travel Amount Food Allowance Total Purpose of Travel
From To Mode of T Kilo Meter
Home (Gottigere,
06/09/2023 Bannerghtta Road) Pratham Internation School, Varthur Auto /Cab 28 487 487.00 Official
Pratham Internation School,
06/09/2023 Varthur Home (Gottigere, Bannerghtta Road) Auto /Cab 30 448 448.00 Official
Home (Gottigere,
07/09/2023 Bannerghtta Road) Siksha Sagar School, Sanjay nagar Auto /Cab 23 868 868.00 Official
Siksha Sagar School, Sanjay
07/09/2023 nagar Home (Gottigere, Bannerghtta Road) Auto /Cab 23 605 70 675.00 Official
Home (Gottigere,
08/09/2023 Bannerghtta Road) Address Health Office Auto /Cab 12 270 270.00 Official
08/09/2023 Address Health Office Home (Gottigere, Bannerghtta Road) Auto /Cab 12 320 320.00 Official
Home (Gottigere,
12/09/2023 Bannerghtta Road) Pratham Internation School, Varthur Auto /Cab 28 592 592.00 Official
Pratham Internation School,
12/09/2023 Varthur Home (Gottigere, Bannerghtta Road) Auto /Cab 30 555 555.00 Official
Home (Gottigere,
13/09/2023 Bannerghtta Road) Siksha Sagar School, Sanjay nagar Auto /Cab 23 490 490.00 Official
Siksha Sagar School, Sanjay
13/09/2023 nagar Home (Gottigere, Bannerghtta Road) Auto /Cab 23 495 75 570.00 Official
Home (Gottigere,
15/09/2023 Bannerghtta Road) ahmaatama (Nagasandra) Auto /Cab 39 114 114.00 Official
15/09/2023 ahmaatama (Nagasandra) Home (Gottigere, Bannerghtta Road) Auto /Cab 39 385 385.00 Official
Home (Gottigere,
20/09/2023 Bannerghtta Road) Siksha Sagar School, Sanjay nagar Auto /Cab 23 453 453.00 Official
Siksha Sagar School, Sanjay
20/09/2023 nagar Home (Gottigere, Bannerghtta Road) Auto /Cab 23 364 364.00 Official
Home (Gottigere,
21/09/2023 Bannerghtta Road) Pratham Internation School, Varthur Auto /Cab 28 724 724.00 Official
Pratham Internation School,
21/09/2023 Varthur Home (Gottigere, Bannerghtta Road) Auto /Cab 30 500 500.00 Official
Home (Gottigere,
22/09/2023 Bannerghtta Road) ahmaatama (Nagasandra) Auto /Cab 39 568 568.00 Official
22/09/2023 ahmaatama (Nagasandra) Home (Gottigere, Bannerghtta Road) Auto /Cab 39 595 595.00 Official
Home (Gottigere,
27/09/2023 Bannerghtta Road) Siksha Sagar School, Sanjay nagar Auto /Cab 23 380 380.00 Official
Siksha Sagar School, Sanjay
27/09/2023 nagar Home (Gottigere, Bannerghtta Road) Auto /Cab 23 447 70 517.00 Official
 Home (Gottigere,
03/10/2023 Bannerghtta Road) Pratham Internation School, Varthur Auto /Cab 28 730 730.00 Official
Pratham Internation School,
03/10/2023 Varthur Home (Gottigere, Bannerghtta Road) Auto /Cab 30 476 476.00 Official
Home (Gottigere,
04/10/2023 Bannerghtta Road) Siksha Sagar School, Sanjay nagar Auto /Cab 23 1104 70 1174.00 Official
Siksha Sagar School, Sanjay
04/10/2023 nagar Home (Gottigere, Bannerghtta Road) Auto /Cab 23 476 476.00 Official
Home (Gottigere,
05/10/2023 Bannerghtta Road) Pratham Internation School, Varthur Auto /Cab 28 600 600.00 Official
Pratham Internation School,
05/10/2023 Varthur Home (Gottigere, Bannerghtta Road) Auto /Cab 30 640 640.00 Official
Home (Gottigere,
10/10/2023 Bannerghtta Road) Pratham Internation School, Varthur Auto /Cab 28 580 580.00 Official
Pratham Internation School,
10/10/2023 Varthur Home (Gottigere, Bannerghtta Road) Auto /Cab 30 594 594.00 Official
Home (Gottigere,
13/10/2023 Bannerghtta Road) Pratham Internation School, Varthur Auto /Cab 28 570 570.00 Official
Pratham Internation School,
13/10/2023 Varthur Home (Gottigere, Bannerghtta Road) Auto /Cab 30 646 646.00 Official
Home (Gottigere,
25/10/2023 Bannerghtta Road) Siksha Sagar School, Sanjay nagar Auto /Cab 23 610 70 680.00 Official
Siksha Sagar School, Sanjay
25/10/2023 nagar Home (Gottigere, Bannerghtta Road) Auto /Cab 23 570 570.00 Official
Home (Gottigere,
26/10/2023 Bannerghtta Road) Pratham Internation School, Varthur Auto /Cab 28 570 570.00 Official
Pratham Internation School,
26/10/2023 Varthur Home (Gottigere, Bannerghtta Road) Auto /Cab 30 646 646.00 Official
Home (Gottigere,
30/10/2023 Bannerghtta Road) Siksha Sagar School, Sanjay nagar Auto /Cab 23 417 417.00 Official
Siksha Sagar School, Sanjay
30/10/2023 nagar Home (Gottigere, Bannerghtta Road) Auto /Cab 23 355 70 425.00 Official
Home (Gottigere,
31/10/2023 Bannerghtta Road) Pratham Internation School, Varthur Auto /Cab 28 610 610.00 Official
Pratham Internation School,
31/10/2023 Varthur Home (Gottigere, Bannerghtta Road) Auto /Cab 30 630 630.00 Official
TOTAL (A) 1024 20909.00

GRAND TOTAL 20,909.00

LESS ADVANCE :
BALANCE CLAIM / REFUND 20,909.00

Sign of Employee : Sign & Name of HOD :

Date :

Sign of HR : Sign of Accountant :

Date : Date :