Blu-Smart Charge Pvt Ltd E: info@blu-smart.

com
A-2,12 Floor,Palladium,Corporate W: www.blu-smart.com
Road,Prahladnagar,Opp.Vodafone T: +91 8287000500
House Ahmedabad – 380015 Gujarat

Reimbursement Claim Date :

1. Details of the Employee:

Name : :

Division :

Department :

Date of Travel:

Outcome :

Mobile No :

2. Details of Expenditure:

S.No Expenditure Amount Total

1 Travelling / Fooding / Boarding
2 Telephone
3 Printing & Stationary
4 Misc. Exp.
5 Business Promotion Exp.
Total

3. Source of Payment:

S.N Mode of
Particulars Amount
o Payment

1 Previous Balance

2 Advance Received Bank Transfer

3 Total Expenditure
4 Amount Retained
5 Amount Received Bank Transfer

_______________ _______________
Signature Signature
(Self) TL (RM for TLs)