CPF (INDIA) PVT LTD No.

A P 0 5 D C 2 6 3 6

Diesel, Petrol consumption Report and other expense Date 25/11/2023

SECTION: A REQUESTOR DETAILS
Name (full name) : DOLA BODANANDAM Employee ID I N 0 0 1 0 3 8 8
Department : SALES & MARKETING PCA 5 2 3 5 1 0 4 0 0
Position : SENIOR TECHNICIAN CCA 5 2 3 5 1 0 4 1 0 3
Work Location : CAP6_CHINCHINADA MARKET Vehicle Model HERO PASSION PRO
Vehicle License Number : A P 0 5 D C 2 6 3 6 Vehicle Type 6. Company,Leasing (2 Wheeler Petrol)
Claim Rate : As per invoice attached Travelling Period 26 / 10 / 23 - 25 / 11 / 23
SECTION B : MILEAGE CLAIM DETAILS
Meter Reading Fuel Bill details Other Expense
PERSONAL
Date Total Amount Amount Place of work
From To USAGE Bill no. Litre Toll Gate Parking
(Credit Pump.) (Pay by Cash)
Thu 10/26/2023 107,046 107,099 53 64 4.92 550.00 Elamanchili
Fri 10/27/2023 107,099 107,147 48 Chinchinada
Sat 10/28/2023 107,147 107,196 49 Yenuguvani lanka
Sun 10/29/2023 107,196 107,227 31 Utada
Mon 10/30/2023 107,227 107,285 58 Medapadu
Tue 10/31/2023 107,285 107,332 47 57 5.37 600.00 Navarasapuram
Wed 11/1/2023 107,332 107,387 55 Chinchinada
Thu 11/2/2023 107,387 107,422 35 Kaza
Fri 11/3/2023 107,422 107,467 45 Kalagampudi
Sat 11/4/2023 107,467 107,509 42 Badava
Sun 11/5/2023 107,509 107,509 Palakollu office
Mon 11/6/2023 107,509 107,560 51 79 5.01 560.00 Elamanchili
Tue 11/7/2023 107,560 107,618 58 Medapadu
Wed 11/8/2023 107,618 107,618 Palakollu office
Thu 11/9/2023 107,618 107,673 55 Navarasapuram
Fri 11/10/2023 107,673 107,673 Palakollu office
Sat 11/11/2023 107,673 107,673 Palakollu office
Sun 11/12/2023 107,673 107,673 Palakollu office
Mon 11/13/2023 107,673 107,702 29 Digamarru
Tue 11/14/2023 107,702 107,734 32 Kaza
Wed 11/15/2023 107,734 107,777 43 254 4.92 550.00 Chinchinada
Thu 11/16/2023 107,777 107,819 42 Elamanchili
Fri 11/17/2023 107,819 107,854 35 Kalagampudi
Sat 11/18/2023 107,854 107,905 51 Navarasapuram
Sun 11/19/2023 107,905 107,934 29 Chittavaram
Mon 11/20/2023 107,934 107,975 41 Yenuguvani lanka
Tue 11/21/2023 107,975 108,028 53 91 4.92 550.00 Badava
Wed 11/22/2023 108,028 108,063 35 Polavaram
Thu 11/23/2023 108,063 108,088 25 Kaza
Fri 11/24/2023 108,088 108,088 Palakollu office
Sat 11/25/2023 108,088 108,088 Palakollu office
1/0/1900 -
1/0/1900 -
1/0/1900 -
1/0/1900 -
1/0/1900 -
1/0/1900 -
1/0/1900 -
1/0/1900 -
1/0/1900 -
1/0/1900 -

Total 1,042 - 25.14 - 2,810.00 - -

Distance Actual Claim

Mileage Start 107,046 KM. 1.On Credit (Company Pay) - Rs.
Mileage Ending 108,088 KM. Paid 2. By Cash (Employee Pay) 2,810.00 Rs.
Total Usedsage 1,042 KM. Total 2,810.00 Rs.
Analysis Deducted Personal Usage KM. - - Rs.
Total Petro (Bill) 25.14 Litre Toll Gate Claim - Rs.
Total Mileage 41.45 KM./Litre Parking Fee Claim - Rs.
Total Expenses 2.70 Rs./KM. Total Claim 2,810.00 Rs.
REQUESTED BY REVIEWED BY HR APPROVED BY HOD * APPROVED BY BU HEAD

Name DOLA BODANANDAM Name SRINIVASA LRD Name DR.R.RAJKUMAR SINGH Name MR.Sirapong Na pongsa

Position A.S.M Position A.G.M Position A.V.P Position S.V.P

Date 27 11 2023 Date 27 11 2023 Date 27 11 2023 Date 27 11 2023

V5
Remarks
1. Do not change/delete/modify Form ,otherwise will not be used for reimbursement.
2. Only in March, the reimbursement must be made until 31st March
3. The fuel bills must be mentioned "company name", " mileage" and "vehicle license number"
4. Need BU HEAD approved when sum of travelling distance -KM. exceed Policy's descripts. (2 wheelers = 1,700 KM/M, 4 Wheelers = 3,400 KM/M)