Reimbursement Submission Form for FY 2023-2024

(Statement showing particulars of claims by an employee for deduction of tax under

ANHEUSER section 192 - Form12BB(See rule 26C) as applicable)

[ Employee Details ]
Employee ID : 40057061 Date of Joining : 07-Apr-2022
Employee Name : Arunkumar M Date Of Submission : 08-Aug-2023
Claim Number : 58

PHONE

Sl. Bill No Bill Date Description Of Expenses Claim Amount

1 BM2436I003105844 27 Jul 2023 Mobile 1588.00
Total 1588.00

DECLARATION:
I, Arunkumar M, son/ daughter of Murugesan, do hereby certify that the information given above
is true & correct and due care has been taken to avoid duplicate submissions. I confirm that I will preserve all the original
receipts/bills and produce the same for verification when required.

Place:

Designation:

Signature

Date : 08-Aug-2023