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HRCPC - Annexure - A Te Da Claim Form

This document is a claim form submitted by an employee for reimbursement of travel expenses incurred during work-related visits. It includes details of dates, locations visited, purpose of visits, mode and cost of transportation, number of days and diem allowance claimed. The employee provides basic information and signs to verify the claim. The form is then recommended and sanctioned by the appropriate authority for reimbursement.

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Atul Gupta
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817 views1 page

HRCPC - Annexure - A Te Da Claim Form

This document is a claim form submitted by an employee for reimbursement of travel expenses incurred during work-related visits. It includes details of dates, locations visited, purpose of visits, mode and cost of transportation, number of days and diem allowance claimed. The employee provides basic information and signs to verify the claim. The form is then recommended and sanctioned by the appropriate authority for reimbursement.

Uploaded by

Atul Gupta
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Annexure - A

(HEAD OFFICE, MANDVI, BARODA)

CLAIM FOR REIBURSEMENT OF BUS / TRAIN / TAXI FARE AND DIEM ALLOWANCE

BRANCH :______________________ BR.ALPHA __________________ REGION ____________________


I, the undersigned Mr. /Mrs./ Ms._____________________________________________________ E C No.____________ Working as __________________ (Designation)

Basic pay ` _____________ p.m. submit my bill for expenses incurred towards the Bus/Train/ taxi Fare and Diem Allowance as under :-

SR.N DATE & TIME DATE & TIME PLACE VISITED PURPOSE OF VISIT / MODE OF BUS/TRAIN / BUS / TRAIN DIEM TOTAL CONVEYANCE HOTEL TOTAL OUT COME OF VISIT Amt.
O. Outward Returned to AUTHORITY TRAVEL & TAXI FAIR / TAXI FAIR ALLOWANCE DIEM CHARGES EXPENSES AMOUNT OF of Deposit
(a.m./p.m.) Head Quarter DISTANCE (IN FOR FOR NO.OF DAYS ALLOW. ` ` CLAIM Mobilised/Amt. of
(a.m./p.m.) KMS) TRAVELLED OUTWARD INWARD (1/4, 1/2, ` ` Recovery, If Any etc.(In
` ` 3/4, FULL) Details)

TOTAL

Yours faithfully,

Verified / Recommended Sanctioned ` _____________


Signature of Applicant
( )
E C No. ________________

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