Expenses Claim Form

Date 13.12.2023 SI. No.

From 13.12.2023 To 13.12.2023

Name Department Employee Code Cost Centre No.

Abhineet Kr. Tiwary Finance VXT2235 69540

Claimable With Amount

Particulars Bill No. Account No.
Supporting Bills Rs. P.
Speed Post Charges Yes - 130 0

Total: Rupees One Hundred Thirty Only 130 0.00

Note: All the above expenses are in accordance with entitlement.

Claimant Checked By Approved By

 TRAVEL EXPENSES ANNEXURE 6.5.1 Doc Code

STATEMENT Doc No.

Date
To be filled by accounts

Name Emp. No. Grade Sale Order No. Cost Centre TI No.
69540
Purpose of visit
Date Total
Departure Place
Time
Arrival Place
Time
Tickets By Co.
Purchased By Self

Accommodation Allowance/
Actual

Food Allowance/Actual
Location Days Amount Conveyance Expenses (give details in column (CX) below)
Out of Pocket Expenses (Days x Rate)
Telephone (exclude from Hotel Bill)
Entertainment Expenses
Minral Water
TOTAL EXPENSES (T)
CX Date From To Mode Amount ADVANCE DETAILS
A Location Ticket No. Amount
TICKET
BY
CO.
B Location Ticket No. Amount
CASH
ADV.
C Location Ticket No. Amount
CREDIT
CARD
Total Advance D=A+B+C
Amount due to Company (D-T)
Total (CX) Amount due from Company (T-D)
Payment Voucher
Signature Date Received the balance amount of Rs.
Employee
Checked by

Approved by Signature of Employee

All amounts in Rupees Round off fractions to nearest rupee Copies to : Accounts
Cashier
** Use additional sheet if required
File
 SERVICE PROVIDER AGREEMENTS STATUS
Contractor Purpose Start Period End period Remarks
Housekee
Vema
ping 3/22/2022 3/21/2023 PO No - 2010001345
Hospitality
Agency
Security
SIS Security 3/22/2022 3/21/2023 PO No - 2010001346
Services

Sujeet Singh Transport

3/22/2022 3/21/2023 PO No - 2030001143
Rathore er

Dev Mata
Car Rental 3/22/2022 3/21/2023 PO No - 2030001528
Travels

Geo
Buildcon Korba WS
5/15/2021 5/14/2026
Private Rent
Limited

Shri Ram
Canteen 3/22/2022 3/21/2023 PO No - 2010001347
Hotel
Mamta Drinking
3/22/2022 3/21/2023 PO No - 2010001348
Industries Water

Safexpress Freight PO No - 2030002484

Pvt Ltd 7/1/2023 6/30/2023
MENTS STATUS
Remarks as on today

Form-B raised on 20.04.2023, HR head

approval pending

Form-B raised on 20.04.2023, HR head

approval pending

Form-B for new agreement Under

Process

Currently no transactions with this

Vendor

Invoice processing by HO w/o PO

Form-B raised on 19.04.23 Approved

forwarded for PO
Form-B raised on 19.04.23 Approved
forwarded for PO

PO valid for 01.07.2022 to 30.06.2023