Mobile Bill Reimbursement Form

Staff Name SURYAKANTA NAYAK Location BALANGIR.ODISHA

Staff ID V5281103 Department APLIANCES

Designation RSO Reporting Mgr Name BIDYADHAR DASH

Entitlement
Month & Year Bill No Bill Date Bill Amount Claim Amount Remarks
(Rs.)

Aug-23 02.08.2023 500 499 499

500

500

500

500

500

500

Staff Signature Approved By (name & Signature)

01.09.2023

Checked By (name
Date of Submission
& Signature)